Herd immunity by a vaccine placebo?
As COVID rages wave after wave, as the “experts” in the “warp speed factory” finally understand how drugs and vaccines are made, and as the life sciences executives clean out their options after Phase I trials, it may be time to get creative. Drug development typically does not coincide with election cycles, but it has been known that humans can be tricked into believing the effectiveness of therapies — in fact, we have a whole industry based on this and it commands nearly 20% of the economy.
The Placebo effect has been the dirty secret of medicine. The first to recognize and demonstrate it was English physician John Haygarth in 1799 (1). Researchers and practitioners have now wholeheartedly embraced the effect as it has been shown that the placebo can be as effective as the active ingredient for many conditions (2). After all, the objective is to make the complex biological system, that is poorly understood, behave in beneficial ways. Great statistical tricks have been devised to convince the patients, providers, payers, and the regulators that the drug actually works. And in many cases they do.
There is solid science behind the placebo effect. Contrary to popular belief, patients don’t just imagine placebo responses. Rather, numerous brain-imaging studies have confirmed that placebos cause measurable changes in neurobiological signaling pathways (3). Humans are funny creatures and their brains are very responsive to suggestions. Placebopathy, the art of practicing medicine with placebos and good bedside manner, could be at least as effective as modern medicine and certainly superior to the plethora of “alternative medicine,” domains.
My experience in a large pharmaceutical company in the 90s could be instructive. In animal trials, we found a compound that was extremely safe. Subsequent attempts to find a target for the compound failed. In retrospect, we could have brought that drug to market for any disease and it would have been a blockbuster. With a hitherto unknown safety window, the drug would have had an extremely high therapeutic index with just a mild placebo effect, to the delight of everybody involved.
According to the CDC, the flu vaccine can reduce the risk of flu illness by between 40% and 60% among the overall population during seasons when most circulating flu viruses are well-matched to the flu vaccine viruses (4). There appear to be two hedges in this statement — first, the claim of 40% to 60% success rate and second, it has to be “well-matched,” to the virus that is circulating. So if there is only a 75% chance of matching the virus well, the success of a flu vaccine in any season is less than 40%. If the placebo effect is well in excess of this, couldn’t we just use a placebo instead of spending all the effort to create a vaccine? Granted, the machinery behind the medicine is important, as ably demonstrated by the great marketing arms of pharmaceutical companies.
Now the problem at hand, COVID. It may be possible for one of the great companies engaged in a mad rush to an effective vaccine to create a placebo vaccine. It will likely have a 50% effectiveness. And, that may be sufficient to reach herd immunity to the delight of politicians, who only care about getting elected.
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