Editorial: In a compelling preponderance of clinical trials,

Question

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Editorial : In a compelling preponderance of clinical trials, patients who were administered sugar pills on a daily basis reported equally significant improvements in mood as did those patients who were administered FDA-approved antidepressants. Most insurance policies offer policy members only limited coverage for prescriptions of antidepressants, and consequently most such drugs carry an almost prohibitive out-of-pocket cost to consumers. Therefore, medical practitioners (and the media) have a duty to make these clinical findings known to the public, so that those patients who would benefit from such drugs may begin to administer equally effective (and eminently affordable) treatment to themselves, straight out of the kitchen cabinet.

Which of the following, if true, is most damaging to the editorialist’s argument?

A. Each of the clinical trials was conducted over a relatively short period of time, and antidepressants often incite an initial spike in mood which is followed by a return to the original melancholy.

B. The clinical trials based their assessment of mood improvements solely on self-reported data; no objective physiological indicators were measured.

C. The improvements in mood were primarily attributable to the participants’ ongoing belief throughout the trials that they were taking prescription antidepressants.

D. Due to necessary discounting of some participants’ data, the total number of subjects in the sugar pill groups was far greater than the total number of subjects in the FDA-approved antidepressant groups.

E. Most people would be skeptical that taking a substance as common as sugar would bring about a noticeable increase in their mood.

OE to follow

iPen · Answer

C. The improvements in mood were primarily attributable to the participants’ ongoing belief throughout the trials that they were taking prescription antidepressants.

Placebo effect is nullified and thus, sugar is no longer effective. If patients knowingly take sugar from their kitchen cabinets, then it won't have its desired effect.

vs.

E. Most people would be skeptical that taking a substance as common as sugar would bring about a noticeable increase in their mood.

This has more to do with the reception and retention of sugar as a treatment, as opposed to the effectiveness of the sugar pill itself. It's valid insofar as people may not even consider sugar as treatment for depression (so, at least in the short term, sugar pills may be ineffective because it's not taken seriously enough as a treatment to be taken at all - if no one uses it, it's ineffective), though it doesn't undermine sugar's inherent effectiveness.

C is the answer because there's no room for doubt on the inherent (in)effectiveness of sugar.

Nevernevergiveup · Answer

Editorial: In a compelling preponderance of clinical trials, 
patients who were administered sugar pills on a daily basis reported equally significant improvements in mood as did those patients who were administered FDA-approved antidepressants. 
But Antidepressants are costly to consumers and have limited concessions from insurance people. 
Therefore, public needs to be informed that sugar can be taken simply instead of antidepressants.

Which of the following, if true, is most damaging to the editorial's argument?

A. Each of the clinical trials was conducted over a relatively short period of time, and antidepressants often incite an initial spike in mood which is followed by a return to the original melancholy................. this doubts the validity of the trails indicating its time period but gets against Antidepressants thereby strengthening the conclusion.

B. The clinical trials based their assessment of mood improvements solely on self-reported data; no objective physiological indicators were measured.................. This catches our attention saying that no indicators are measured trying to weaken trial validity again. But self reported data can be either correct or Incorrect. Thereby nothing can be surely concluded from this option.

C. The improvements in mood were primarily attributable to the participants’ ongoing belief throughout the trials that they were taking prescription antidepressants............. So the patients believed that they took antidepressants instead of sugar pills and their belief and confidence in antidepressants seemingly helped them to recover. Although we can say that sugar pills helped them we cannot guarantee the same since the similar result cannot be expected when public/participants know that substance undertaken by them is sugar not antidepressant.
 
D. Due to necessary discounting of some participants’ data, the total number of subjects in the sugar pill groups was far greater than the total number of subjects in the FDA-approved antidepressant groups................. .number of subjects is out of concern here

E. Most people would be skeptical that taking a substance as common as sugar would bring about a noticeable increase in their mood.................. This goes against the conclusion since public may not believe it but again they may do so after some time or by believing in clinical trails result. Not really strong weakener since there is a whiff of uncertainty.

Ekland · Answer

Hi  mikemcgarry ,
I understand the placebo thing.
But if the guys really got "cured" bcos of their faith in the drug and not the effect of the drug, then announcing to general public that sugar cures depression will also make them place similar faith in the sugars straightoutathecounter.

I understand the placebo thing.
The end result being. IT WASN'T THE DRUG THAT CURED YOU. but you can't say YOU WEREN'T CURED. 
It attacks the authenticity of the drug not the curing. If you are tricked into getting cured, the curing remains a trick. But your curing remains a curing.

The manner that question was constructed is a little out of place.
This is a waekener.
It's supposed to weaken the conclusion that: TELLING THE PEOPLE THAT A TRIAL HAS PROVEN SUGAR TO BE ANTIDEPRESSANT, BECAUSE SOME PERDONS TOOK IT AND GOT CURED, WILL GET THEM USE SUGAR AS ANTIDEPRESSANT AND GET CURED AS WELL.

FDA ones might as well be placebos.

I want to see a similar question from GMAC.

Nevernevergiveup · Answer

Please go through mike solution thoroughly. He clearly explained why C  but not B  is the correct choice.

Option C says The improvements in mood were primarily attributable to the  participants’ ongoing belief  throughout the trials  that they were taking prescription antidepressants .

Note bolded portions. This means that participants were under impression that they were using antidepressants and they were ignorant regarding sugar pills. If the results leak to public, then they will be aware of truth by those results. It is not mentioned in the argument I explained through that instance.

mikemcgarry · Answer

Dear Nez, I'm happy to respond. :-)

This is very subtle and requires a subtle understanding of the placebo effect . My friend, you say that you understand the placebo effect, and that's a dangerous place to be, because when you claiming that you already know all there is to know on a topic, that can make you less than fully receptive to all the new things you still have to understand about the topic. This is a solid CR question: it's just that you have some subtle misunderstandings of the placebo effect. You are perfectly right that once the results are announced, once the cat is out of the bag, then the effect would be over. The placebo effect comes from people thinking, believing, that they are taking real medicine. Once they know the sugar pills are just sugar pills, the placebo effect wouldn't work anymore. If this were announced in the middle of a study, that would be disastrous for the study: it would be a major violation of ethical norms. My sense of the prompt argument is that the studies cited were all finished and in the past, so the editorial wasn't disrupting any studies in progress. Keep in mind: every single person was told, "You are taking an anti-depressant." Even the folks given the placebo were told this. Thus, when the study is over, none of the cured people will have any idea whether what they took was a placebo or the medicine. In the aftermath and debriefing of the study, everyone well-informed would realize that it wasn't the sugar itself that was curative, but the belief that was curative. Thus, no one will have any inclination to place any belief in sugar. Also, I think are confused about the nature of the belief needed for the placebo effect to take place. You see, the medical sciences have considerable prestige in the modern world, because all their conclusions have the backing of scientific research. Thus, when a medical doctor hands us a pill and says, "this will cure you," we are inclined to place considerable faith in what that doctor is doing. By contrast, a commercial or an announcement in a newspaper or an anecdote may suggest something, but there's no way that something of this sort will rise to the same level of credibility of the whole of the medical sciences. In the 1970s, double-Nobel Laureate Linus Pauling made the claim that Vitamin C cures cancer. He was arguably the greatest scientist alive at that point, and he really believed it. He even did a scientific study that generated positive results. Well, no one could reproduce his work, and no matter how much credibility this super-genius had, it wasn't enough for people to get cured from cancer believing in him. Compared to this, the authority of science as a whole is truly extraordinary. I think you don't understand how the FDA works. It would be illegal and unethical for the FDA to offer as medicine a placebo. Before the FDA is willing to call any substance a medicine for some disease, there must be thousands and thousands of hours of lab work: biochemical tests, rat studies, etc. The whole claim of any up-and-coming medicine is that it can outperform the placebo effect. When the FDA claims that something is medicine, it has the backing of an enormous amount of scientific data. Remember, when the FDA announces that something is a successful medicine, it is not merely announcing this to doctors and patients in need of treatment. It is also announcing this to biochemical researchers who will analyze that substance and try to use its successful properties to manufacture new medicines for other diseases. For the FDA to announce something is a medicine and then have it turn out to be a placebo would be considered the highest breach of the norms of scientific research: dozens of people would lose their jobs and some would be thrown in jail. Finally, in some ways, your questions point to a central paradox. The placebo effect points to the powerful role of belief and the body's ability to heal itself of all kinds of ailments. One would think this would be a valuable avenue for the medical sciences to explore. In fact, the placebo effect is considered a "nuisance" in scientific work, because in research one always has to design a study to demonstrate that a medicine outperforms a placebo. Certainly no medicine certified by the FDA is just a placebo, and in fact, it would be illegal and immoral for any company to offer an over-the-counter medicine for something that is really just a placebo. Presumably every medicine, in addition to doing whatever it does, also stimulates the placebo effect, but in order to be a valid medicine, it must be doing more. If a company were discovered doing that, it would be shut down by the government immediately. Except in very bizarre marginal cases, no one, absolutely no one, intentionally uses the placebo effect to cure anyone, even though it seems to indicate that the human body has tremendous innate powers of healing. The human body itself may have more power to heal than all the medicines on earth combined, but no one knows how to tap into that vast healing power in a systematic way. That's the paradox of medicine in the 21st century. Does all this make sense? Mike :-)

Ekland · Answer

Remarkable detail. Thanks a bunch.
it does make sense  mikemcgarry  It's clear to me that C is a weakener.
But option B seems a weakener as well.
  clinical trials based their assessment of
mood improvements solely on self-reported data;
no objective physiological indicators were
measured 
This assumes that mood improvement is important factor in determining improvement from depression.

So my question as regards that is. Do objective physiological indicators hold less relevance in neurological medicine than the patients' own claim?

Wouldn't that truncate the aforementioned sacrosanct scientific process?

Or is there an established bias in GMAT for the placebo thing carrying more weight? after all the question said WHICH IS MOST DAMAGING I.e on a comparative level.

I'll appreciate.

mikemcgarry · Answer

Dear Nez, I'm happy to respond. :-)

I would say that (B) is a brilliant distractor. You see, with a disease of the blood or something physical, doctors would have very physical measurements to make, numerical tests they could run. Depression is an emotional disorder, and the primary way a doctor diagnoses or monitors it is by asking, "How are you feeling?" There are secondary indications in patient's behavior (disrupted sleep, poor appetite, social withdrawal, etc.) but of course, like mood, those also would be gleaned from self-report. There is no simple measurement that a doctor could do to test for the severity of depression and whether it is getting better or worse. Presumably, there are $100,000 procedures that research scientists could run on each individual that would be more definitive, but obviously such procedures are impractical because of cost. Thus, the primary diagnostic tools for depression at the disposal of an ordinary physician necessarily come through the self-report of the patient. Choice (B) is a chimera. In the absence of super-expensive neurobiological procedures, there are no physiological tests for depression. Every ordinary non-research physician would diagnose and monitor depression purely through the self-report of the patient. It doesn't make sense to single out a particular set of procedures and criticize them for what is standard practice in the medical world. Does this make sense? Mike :-)

Ekland · Answer

Makes sense 50%.
You lost me here.
  Every ordinary
non-research physician would diagnose and
monitor depression purely through the self-report of
the patient. It doesn't make sense to single out a
particular set of procedures and criticize them for
what is standard practice in the medical world.
Does this make sense?

I guess you know why you lost me there?

The stimulus is talking about what? A research not a hospital visit.

Also
u said B is a chimera. i.e. looks less definite to be a weakener. Right? Cos chimera means
to my understanding, something that seems this or the other depending on how you look at it.

I'll appreciate.

Posted from my mobile device

mikemcgarry · Answer

Dear Nez, I'm happy to respond. :-)

Yes, these were clinical trials, trials in which pills were given. Let me explain. In a doctor's office, with ordinary doctor office equipment, the only way to diagnose depression would be self report. In a clinical trial in which pills are being given, a clinical trial with a budget of, say, a few thousand dollars, the only way to diagnose depression would be self report. If we wanted to get an "objective" measure of depression, a measure entirely independent of self-report, I am not even sure this would be possible. It might be possible with advance brain scans, for example, those using positron emission tomography , looking at the brain regions that were active. Here, we are talking about machines that cost hundreds of millions of dollars, and each use of the machine might cost tens of thousands of dollars. These machines are used when a patient has a major brain injury and it's necessary to help them. These machines are also used in neurobiological research, funded by the government and scientific institutions. No individual research, testing some batch of pills, is going to have the budget to get a hold of one of those machines. Furthermore, it's not clear to me, even with the most advanced brain scanning machines on the planet, that we would be able to say, definitively, that a certain person is definitively depressed or definitely not depressed. Thus, no matter how much money we spend, hundreds of thousands or millions of dollars, we might still be left with self-report as the best measure of whether someone is depressed. This is why (B) is a chimera (a thing that is hoped for but in fact is illusory). It looks like a promising weakener, but the objection it makes is something that perhaps no one on the planet could avoid. It would equivalent to someone saying you are a bad person because you can't flap your arms and fly: if no one can do this, there would be no reason to single you out for blame. Does this make sense? Mike :-)

Ekland · Answer

You've tried. Yes you've tried, even though I have more loads of questions from your response.
The placebo effect option is the MOST damaging option.
I guess the veritas question lab guys had something in mind before they specified the question stem.
Have a kudos sir.

Posted from my mobile device

kitipriyanka · Answer

Conclusion says to let people know about sugar pills but this complete experiment is based on the belief of the people taking sugar pills that they were actually consuming antidepressants.
Now when people would know that they're consuming sugar pills, we don't know what would be the result.

Hence C

krishsaisree · Answer

Still not convinced as to why Option B is incorrect. 
Here's my reasoning:
 B. The clinical trials based their assessment of mood improvements solely on self-reported data; no objective physiological indicators were measured. 
-->   If no objective indicators were used, it is possible that the test itself wasnt conclusive and that the author is pushing his argument too far. This is a test designed to understand effect of the medicine and the option directly questions the set up of the test itself  
 
C. The improvements in mood were primarily attributable to the participants’ ongoing belief throughout the trials that they were taking prescription antidepressants. 
-->   i get that what the patients reported was rather due to the feeling of being given an antidepressant, than the effect of the antidepressant itself

Could someone please help me understand why Option B is incorrect?

dcummins · Answer

The argument   is that medical practitioners should make these clinical findings known to the public so patients would benefit in the same way as the sugar pill takers in the trial.
This is  based on  the study in which patients who were administered sugar pills were found to share the same benefits as those administered antidepressants.

A is incorrect because both drugs were administered over the same period, so the benefits may still be present.
B is incorrect because both types of patients were self-reported, so the benefits may still be present.
C is correct because the general public won't be told that what they are consuming is something else, instead they will know that what they are consuming isn't an antidepressant. 
D if anything strengthens the argument as it solidifies the data through greater representativeness. Incorrect
E is incorrect because skepticism doesn't translate to negation of the benefits.
For example, I could be skeptical that drinking 1 litre of vodka will make me intoxicated, but my skepticism can't control the physiological affect of consuming 1 litre of alcohol. I'll be drunk (or dead).

gaurav2m · Answer

Hi mike/ VeritasKarishma ,

As per your reasoning for option B, isn't that reasoning can be used for weakening the argument as people may have a motive to lie about their condition.
which means, sugar is not an effective treatment for depression?

mimishyu · Answer

Narrator: “sugar pills” work as well as “FDA-approved antidepressant” in helping the improvement in mood, also antidepressant is more expensive than sugar pills

Thus(the conclusion): medical practitioners should made this finding known to the public that “sugar pills” are more effective &cost saving in fighting depression than “antidepressant”

I chose (B) and was confused between (B)&(C), after perusing the explanation of mikemcgarry I try my best to sort out the subtlety in these two choices

I thought (B),intuitively, is a choice quite easily for people to get trap into except that you could think of the concept mikemcgarry wrote--that "self-reported" is INEVITABLE in measuring depression, but to speak in truth, its really hard for "ordinary people" like us to call to mind this idea...

to sum up what mikemcgarry said: its only by using self-reported data of mood can we measure depression, even if we know there're some advanced equipments at hand, so we could say, for (B) itself its quite similar to a "non-debatable tool" thus it won’t affect the conclusion& argument

however, if we take into account the “placebo effect”, its no doubt to say choice(C) can constitute a more strong weakner than (B) in weakening the conclusion since what really count to improving in mood/depression is not “sugar pill itself”(conclusion), but rather its ”belief-placebo effect” matters, and all this happen in a situation which all participants don’t know what they really took is “sugar pill” for once they knew this information the whole experiment can’t be established

KarishmaB · Answer

In a trial in which subjects were depressed, some were given anti-depressants and other were given sugar.
Both groups reported equally significant improvements in mood.

Conclusion: Tell people that sugar is as effective as anti-depressants in elevating mood.

We need to weaken the conclusion. We need to say why sugar may not be as effective. People do seem to claim the same effect but it may not be.

A. Each of the clinical trials was conducted over a relatively short period of time, and antidepressants often incite an initial spike in mood which is followed by a return to the original melancholy.

Irrelevant. Saying that after a while anti-depressants don't work is irrelevant to us.

B. The clinical trials based their assessment of mood improvements solely on self-reported data; no objective physiological indicators were measured.

The argument already tells us that people reported significant mood improvement. Considering that depression is a psychological issue, we don't now if there are any physiological indicators that constitute "effective treatment". Let's wait and see.

C. The improvements in mood were primarily attributable to the participants’ ongoing belief throughout the trials that they were taking prescription antidepressants.

Sugar worked in the trial because participants believed that they were taking anti-depressants. A person popping in sugar from his kitchen cabinet will not have this false belief. So he will not see the improvement that was seen in the trial. This weakens the conclusion.

D. Due to necessary discounting of some participants’ data, the total number of subjects in the sugar pill groups was far greater than the total number of subjects in the FDA-approved antidepressant groups.

Irrelevant.

E. Most people would be skeptical that taking a substance as common as sugar would bring about a noticeable increase in their mood.

People will be skeptical of the treatment is not a reason for the treatment to not work. If sugar is an effective treatment, it will lead to mood improvement if people take it.

Answer (C)

ishita27 · Answer

Hi  mikemcgarry  , I totally understand the placebo effect after reading your explanations. However, before reading the explanation I had trouble eliminating A and D, and I ended up choosing A. Can you please highlight how to eliminate A and D?

AdjustedEbitdad · Answer

Hi Mike,

Appreciate the methodological explanation of the Placebo effect. Thoroughly enjoyed the read, and almost forgot about the question while reading! :p

However, I did have a couple of questions regarding option C.

1) At first read I wasn't sure what it meant and which group of people it referred to. 
2) Post some deliberation, the reason I rejected C is because I thought it meant that taking the Anti-prescription drugs created the placebo. Not taking the Sugar pills.

Is there a way I can be sure that option C in fact talked about the group taking sugar pills? Would love your input!

DmitryFarber · Answer

I don't think Mike is posting these days, but I can cover this.

First, it's true that C is very vague.  Which  improvements in mood is C talking about? We shouldn't really have to guess about that to get the question right. So let's consider the three possibilities. C could be referring to improvements in the sugar group, the antidepressant group, or both. 
*If it's the sugar group only, that fits with the general idea of the placebo effect: people's beliefs led them to improve even though they weren't actually taking meds. 
*If it's the antidepressant group only, that's a bit odd: if that group improved due to beliefs, then why did the sugar group improve? And since both groups believed they were taking antidepressants, why wouldn't belief help the sugar group, too? Are we supposed to imagine that this group improved because they had a very very mild sugar shortage? (Also, in real life, sugar pills are a standard placebo--the point is to use a substance that doesn't really do anything. A medication is not a placebo.) When you push on this interpretation, it doesn't hold up. 
*If it's both groups, this implies that belief is more important than the actual substance in question. Like the first interpretation, this is consistent with the idea of a placebo effect. In fact, this is really the best way to interpret the statement. First, in pure test terms, if the text says "the improvements" and doesn't specify which one, we should default to assuming that it's all of them. Second, in scientific terms, if belief is the main driver of recovery for a certain treatment, then belief should play a role whether we're taking real meds or not.

In any case, whether we read this as "sugar only" or "both groups," C undermines the idea that we can  knowingly  take sugar pills and benefit. If you're reading it as "antidepressants only," you need to dig in a bit more to make sense of the data.

Editorial: In a compelling preponderance of clinical trials,

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Editorial: In a compelling preponderance of clinical trials,

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