The World Congress on Drug Discovery and Development, 2016, Bangalore!

Where do I start!

As pharmacologists, the idea of a world congress on drug discovery and development, along with the presence of eminent personalities like our honourable President and Prime Minister, lured most of us into taking a trip to Bangalore. As an excited student, an amount of rupees 4.5K didn’t seem much back then. But now, I can undoubtedly say that we got duped, with respect to both time and money.

Going back a few months, the first time the congress got announced on the web, the pharmacological society was thrilled. Something new in the market! Too much enthusiasm! New studies were started, completed and drafted for presentation to the congress, in the hope of an amazing audience. Here, a little praise for the marketing skill of the web developer as well as the organizing committee requires a mention! Bravo!

Everything said and done, the programme schedule was no awaited. It came, yes, it did; a week before the meet. It was then when people realised that ‘The World Congress on DRUG Development and Discovery’ was amalgamated with a Conference on ‘Gerontology and Geriatrics’. Ouch! Too late to back out now! We were also informed that the schedule was different than the one posted on the web, so we need not worry. Lies!

We, as doctors, don’t mind learning something about old age and related problems, no. What we do mind is being misinformed about the actual purpose of the conference! Still, we attended.

Keeping aside all the chaos, the lectures were scheduled from 8 a.m. to 6 p.m. There was no breakfast on day 1! On days 2 and 3, we did have some tea and cookies. What a relief! The lectures mentioned in the schedule were not the same as the one being addressed. Lie no 2! Also, the paper and poster presentations went alongside with the guest lectures in other auditoriums. Thus, all those who wanted to listen to the guest talks, did miss a few of them.

Let us now talk about the chairpersons. With all due respect to the chairpersons for the presentations, a person informant of a particular subject as a chairperson for a particular session, would’ve been immensely appreciated.

Well, finally, with all the issues mentioned above, the 3 days did come to an end. But they ended with a bang. Credit hours!

As most of us are aware, that every state and every country has its method of writing registration numbers of their doctors. The organizers failed to realise this and made a mess of all the certificates, which of course they had to reprint.

Hence, it wasn’t that great a waste, we at least got credit hours and an up-gradation in our CV. But, if I were asked to attend the same conference being held in Kolkata in 2107, I would think a hundred times, in fact more than a 100 times!!!

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Placebo!

A placebo, in Latin means, ‘I shall please’. It may, however, be defined as a pharmacologically inert substance (saline solution or starch tablets) that seems to produce an effect similar to what would be expected of a pharmacologically active substance.

History

The Placebo Effect was first mentioned at the Cornell conference of therapy in 1946. Eugene F DuBois, a New York physiologist, pointed out that, “Although placebos are scarcely mentioned in the literature, they are administered more than any other group of drugs… Although few doctors admit that they give placebos, there is a placebo ingredient in practically every prescription.” He noted that in fact, “the placebo is a potent agent and in its actions can resemble almost any drug.” At the same conference, Harry Gold added, “The placebo is a specific psychotherapeutic device with values of its own.”

Later in 1962, Kefauver-Harris Amendment of the FDA regulations led to the introduction of Placebo Controlled RCTs as the gold standard to measure the efficacy and safety of new drugs.

Since then various institutions like the National Institute of Health and the Harvard Medical School have opened up centres for placebo research.

What is the placebo effect?

Let us first consider the differences between an active drug and a placebo. They are both efficacious, their responses depend on the dose, they have their own adverse effects as well as abuse liabilities, but the effects of a placebo cannot be predictable while that of the active drug can be.

So, a placebo effect may be described as the beneficial effects that are derived from the context of clinical encounter, including the ritual of treatment and the clinician-patient relationship, as distinct from therapeutic benefits produced by the specific or characteristic pharmacological or physiological effects of medical interventions.

It is a phenomenon that a patients symptoms can be alleviated by an otherwise ineffective treatment, since the individual believes that it will work.

It is also known as – The Belief Effect, Non-specific Effect or Subject Expectancy Effect.

The various pre-requisites for a placebo to work include

  1. The alertness and attentiveness of the patient
  2. The doctor patient relationship – empathy, assurance, complete information about the beneficial effects as well as assurance regarding the adverse effects
  3. The patient – his psychological factors and prior experience
  4. The nature of the disease
  5. The drug itself – whether it is imported, costly, what is the size of the dose, whether it is an injectable formulation, what is the colour as well as the name of the drug. When used for clinical trials the placebo should look, feel, weigh, smell exactly like the active drug for its effect to occur.

Before going into the details of how a placebo works, let us look into the type of healings.

  1. Natural healing – which occurs naturally by the virtue of the endogenous products of our body. For example, wound healing.
  2. Technological healing – includes healing by the virtue of medicines, surgery and other interventions.
  3. Inter-personal healing – a healing that occurs due to the interaction between the clinician (healer) and the patient.

However, all these healing techniques have their own adverse effects. For example, natural healing may lead to autoimmune disorders, technological to iatrogenic reactions and inter-personal to ‘the nocebo effect’.

The Nocebo Effect is the opposite of the placebo effect wherein the person receiving the drug (placebo) experiences the adverse effects instead of the beneficial effects.

How does a placebo work?

The placebo works by the principle of Mind Over Medicine.

As we all know, the brain has a top-down control over all the areas of the body where the placebo works. Thus when the brain undergoes conditioning, the effects of a placebo are seen.

Let us consider an example to understand this concept.

In a study of immunosuppression caused by cyclophosphamide and a placebo, after a few doses of both the drugs, cyclophosphamide was withdrawn and only the placebo was administered. It was found that despite the absence of the active ingredient, immunosuppression was seen, hence proving the theory of brain conditioning.

The other conditions in which the placebo effect has been demonstrated include – acute pain, acupuncture analgesia, Parkinson’s disease, dementia, migraine, psychotic disorders, angina, hypertension, bronchial asthma, cough, erectile dysfunction, drug abuse, ulcerative colitis, etc.

It has been known that when in a situation where survival is of utmost importance, our brain can neglect the pain and anxiety. However, the same is not possible when the person is at rest. A question arises here that when the brain is capable of such a feat why doesn’t it work so when at rest? Why doesn’t the brain use its ‘Inner Pharmacy’ while at rest?

To begin with, we human have been condition since birth to up to individuals with authority whenever in need, like looking up to our parents. When ill, the person’s ability to think, his will and wish are impaired. In such situations, the presence of an authoritative figure, gives us the hope and expectation of relief, thereby activating the ‘Inner Pharmacy’. So, an authoritative figure is nothing but an emotional trigger of hope for relief. This phenomenon explains the placebo effect at its best.

However, one should keep in mind that the placebo acts on the illness (presentation of bodily symptoms) and not on the disease (pathological/physiological states).

 

Note: The above information is collected from various resources.