Do Placebos Really Work?

It seems that sometimes they do

You may not have a positive view of the term ‘placebo’. You may envision sugar pills, medical tricks, or even snake-oil. But placebos are commonly used in medical research. Don’t be too quick to condemn the placebo.

In medical research (clinical trials) a placebo is a neutral substance used as a control in an experiment to determine the effectiveness of an experimental drug or treatment. A related phenomenon known as the ‘placebo effect’ adds new and sometimes surprising information to the mix. Placebo effect usually refers to the beneficial effects of a placebo in relieving symptoms. This occurs about one-third of the time when placebos are used.

The placebo effect works when the patients do not know they are receiving a placebo and believe they are or may be receiving a beneficial treatment. It also seems to work when the patient does know the treatment is a placebo.

Although nobody knows for sure why and how placebos work, researchers have provided numerous studies demonstrating the beneficial effects of placebos. Some researchers believe that placebos help the mind trigger healing or other changes in the body.

Cancer Clinical Trials: A sneak peek inside the book

We are dedicated to sharing knowledge about cancer clinical trials and experimental therapies.  The blog is great for short, focused, fact filled pieces and two-way conversation.  The book is great for telling the whole story.  Together, the blog and the book can cover it all: the big picture, the details, and the conversation.  That's why we get pretty excited whenever we see the book getting a little closer to reality.
We just received the first part of our book from our publisher.  These are the author proofs of the Table of Contents, Preface, and Introduction.  We are excited to share these with you.  If you would like to take peek, go ahead and download these sections.  Happy peeking!

Download Contents and Intro

Download the book cover

To put a smile on your face see Larry's latest cartoon


(c) 2012 Tom Beer and Larry Axmaker

What is cancer?

Cancer comes from within us.  It is a disease of abnormal growth of the cells that make up the organs of our body.  To be lethal, in addition to abnormal growth, cancer cells must acquire the ability to invade other organs and spread throughout the body.  Understanding the key features or hallmarks of cancer is a basis for designing treatments designed to fight it.  The basis features that all cancers share are:

1)  The ability to grow in a self-sufficient manner, regardless of the body’s needs. 

2)  Resistance to the natural anti-growth instructions from the body.

3)  The ability to grow and evade natural death; in a manner of speaking, cancer cells are immortal. When grown in a laboratory, and as long as they are fed, cancer cells grow forever. 

4)  The ability to invade and spread throughout the body

5)  The ability to grow its own blood supply.

To read the original article that proposed these hallmarks of cancer go to:

Hanahan and Weinberg, Cell 2000

Clinical Trials can sometimes have unexpected benefits

As the co-author who has cancer and has participated in clinical trials, I tend to see the patient/participant side of clinical trials more than the medical side. I have participated in three clinical trials and my life has changed in ways not built into the study plan.

I’ll explain. My first trial, more than 15 years ago, was a prostate cancer prevention study. It was a double blind placebo study—half the men got an experimental medicine and half got a pill that was neutral (sugar pill). Nobody knew who got which pill—not the participants, doctors, or nurses. It turns out I took a placebo for several years. My PSA (a potential marker of prostate cancer) was in the normal range throughout the study.

At the end of the study I was offered a free prostate biopsy and agreed to have it. A prostate biopsy takes tissue samples from your prostate by injecting hollow needles through your colon and into your prostate. I never said it was fun. The bottom line was: even though my PSA was normal, the biopsy found a rather large and fast growing tumor. I started treatment shortly thereafter. Without the biopsy it may have been a few years before I was diagnosed, and possibly at a much later and more dangerous stage.

In a second clinical trial, everybody took the experimental drug and it didn’t seem to work for anybody. No harm—no foul.

My third trial was a six month strength building program for men with prostate cancer and their spouses—10 couples in our group.

Cancer Clinical Trials: how to follow our blog

If you are a seasoned blog reader, you may wish to skip this post.  If you are new to the world of blogging, you may be just discovering how to follow the blog.  Here are your options:

1. Email.  The simplest way.  Just register your email in the subscribe by email box.  You will get an email with each new post.  We will never use your email for any other purpose.
2. Join the blog and become a follower.  New posts will appear in your Google Reader and Blogger Reading List.  You will not get an email.  This is a great option if you are a regular user of the Reader or Reading List, but you will get left out if you rely on email for reminders.
3. Subscribe by RSS.  Many email programs have an RSS option.  New blog posts will appear in your RSS inbox.  This is similar to subscribing by email, but instead of mixing the blog posts with your regular email, it segregates them into a separate RSS inbox.  You can subscribe by RSS by clicking the subscribe in a reader icon or you can do it from your email program.  In your email program, look for the add RSS feeds tool and paste in the following URL:  http://feeds.feedburner.com/cancer-clinical-trials.
4. Follow us on Facebook.  Go to our Facebook page at Cancer Clinical Trials on Facebook.  Once you are on our page, click the "Like" button.  Our posts will appear in your Facebook newsfeed.
5. Follow us via Twitter.  Look for the Twitter button on the right hand side.  All our blog posts go out on Tom's twitter feed. 

We plan to post new articles once or twice a week, so whatever option you choose, we hope to  inform you but not overwhelm you.


To put a smile on your face see Larry's latest cartoon

Cancer therapy: from one-size-fits all to custom designed

     Most cancer treatment today can be described as “one size (hopefully) fits all.”  We try a “standard” drug in all patients with the same cancer.  Some patients get a lot of benefit from treatment, others very little or no benefit at all.  Some patients have severe side effects, others very few.  We find this out by trying medications and hoping for the best.  It often takes a couple of months of treatment before a cancer patient can know if the right treatment was chosen. 

         It is likely that, in the near future, a sample of an individual’s cancer will be carefully and extensively analyzed in the laboratory before any therapy is started. The results of this analysis will allow us to select a treatment that will likely work the first time.  By matching drugs to the specific defects in an individual human being’s cancer, we should be able to avoid the “trial and error” approaches of today.

         In 2011, two new cancer treatments were approved that illustrate this new paradigm. Crizotinib (Xalkori^®) was approved for the treatment of lung cancer that harbors a specific mutation in the ALK gene. Vemurafenib (Zelboraf^®) was approved for the treatment of melanoma, the deadliest form of skin cancer. This drug targets BRAF—a protein that is mutated in nearly half of melanomas and drives the cancer’s growth. Both of these drugs will only be helpful to people whose cancer carries the target mutation and that is why the drugs were approved together with a test to determine if an individual person's cancer is likely to be susceptible.  

     We will see many more such drug–test combinations, and they promise to bring much better results to cancer patients. The approval of these two drugs shows that the era of personalized medicine has begun to arrive. 

New Phase III Cancer Clinical Trials January 2011

Our search today revealed 20 new phase III studies registered in the last 30 days.  As we see every month, there is a broad range of new ideas that are being tested.  Today, we would like to highlight the TRINOVA-3 trial which examines the addition of AMG 386 to chemotherapy in advanced ovarian cancer.  AMG 386 is designed to block angiogenesis, the abnormal blood vessel formation that cancers require to grow.  Cancers grow their own blood supply and drugs like AMG 386 seek to block this process.  In this trial, all patients receive chemotherapy and half receive the experimental drug while the other half receive a placebo that is similar to the experimental drug.  


How do we choose the trial to highlight in these monthly update posts?  Entirely based on our judgment about which trials are testing interesting new agents and also are representative of what is going on in the field.  Angiogenesis is an important feature of cancer and a number of drugs that interrupt it are in clinical trials.  The trial also illustrates one way that modern trials use placebos.  In this trial, no patient will receive no treatment.  All patients receive the current standard and the placebo serves as a comparator to the experimental drug.  


Links to clinical trial searches included in this post expire in 3 months.


A day without laughter is a day wasted...said Charlie Chaplin...and we agree.  Cancer Clinical Trials are a serious subject but in addition to educating you, we would love to bring a smile to your face.  That's why we recommend that after reading this post, you take a peek at one of Larry's Cartoons.

The big trends in medical treatments for cancer

Medications are the mainstay of treatment for those cancers that by their nature or because they have spread, cannot be removed surgically or eliminated with radiation.  Medical treatments are also often added to surgery or radiation to kill the few cancer cells that may have escaped and reduce the chance of cancer coming back.  The broad trends that are driving research into new medications for cancer include:

·        New chemotherapy drugs and combinations of drugs

·        New ways to manipulate the hormones that drive certain cancers (primarily breast and prostate cancer)

·        More specific and targeted therapies that are sometimes referred to as “smart bombs.”  These types of treatments are designed to attack very specific mechanisms that drive cancer growth and spread.  A variety of technologies make targeted therapy possible.  Some are artificial antibodies, synthetic small chemical molecules, and gene-directed therapies

·        Harnessing the immune system to fight cancer

·        All cancer therapy is likely to become more personalized (individualized) with treatments selected to match each person’s unique cancer.