Editorial: In a compelling preponderance of clinical trials, patients

Question

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.

mikemcgarry · Accepted Answer

Dear avohden , I'm happy to help. :-)

This is a classic question on the placebo effect . If you understand that idea from, say, a Statistics class, then that makes this question easy. Here's the basic idea. Any time someone with some illness gets a pill from a doctor, the patient's faith in the doctor is part of what has the effect. Even if the pill has no medical value, a placebo, the fact that a doctor convincingly gave the patient and patient believed the doctor is enough for the patient's body to general healing effect. This has been measured in countless experiments, and it is called the placebo effect --- the healing the results simply from belief in the efficacy of the pill, apart from any medical value of the pill. In medical trials, in order for any new medicine to prove itself effective, it must outperform the placebo effect. A placebo is any pill with no medical value --- sugar pills are common placebos. Of course, what is curative is not what's in the placebo --- sugar --- but rather the faith that the patients had that they were receiving something effective. That, in a nutshell, is the fallacy of the argument, and (C) addresses this. It's true that you don't really have to have outside knowledge to answer GMAT CR questions, but it's also true that if you know about some common real world procedures, that can help a lot. The placebo effect and the nature of medical trials is a good thing to know a bit about. Others include: The Law of Supply & Demand : https://magoosh.com/gmat/2012/gmat-supply-and-demand/ Labor & Wages : https://magoosh.com/gmat/2012/gmat-labor-and-wages/ Inflation, unemployment, and interest rates : https://magoosh.com/gmat/2012/inflation- ... -the-gmat/ The Legal System : https://magoosh.com/gmat/2012/beyond-any ... -the-gmat/ Statistical significance : https://magoosh.com/gmat/2012/statistica ... -the-gmat/ Profits & Non-profits : https://magoosh.com/gmat/2013/profit-and ... -the-gmat/ I hope all this helps. Mike :-)

mikemcgarry · Answer

Dear akashb106 First of all, be very careful with precise phrasing. (B) doesn't say the results were " self-recorded " but rather " self-reported ". That's a HUGE difference. If the data were "self-recorded", that would meet each participant were writing down all the data him or herself, and of course, many people would flake and forget to write stuff down, and the resultant collection of data would be entirely useless from a scientific point of view. That's not what (B) is saying. Mood is "self-reported" in the sense that the only way a researcher has of determining a subject's mood is by asking them, verbally, "how do you feel?" or "what mood do you have?", and getting verbal information in response. In some cases, self-reported information is not particularly reliable, especially if the subject has some motivation to lie or stretch the truth --- consider asking the questions " are you honest ?", " have you ever broken the law ?", " do most people like you ?", " have you ever hurt someone on purpose ?". With questions such as that, people may consciously lie, or they may just have an unrealistic picture of themselves, and thus the self-reported response might not be reliable. For example, if I ran a research project, and asked 200 people in a city "have you ever committed a felony?", and they all said "no", it would be a pathetically gullible conclusion for me to say --- well, none of them were lawbreakers! In such a research project, the problem of "self-reported" data is huge. By contrast, in this case, people take a pill for a few weeks, and then we ask them, "do you still feel depressed?" or "has the pill you were taking helped your depression?" Yes, maybe one person would lie, but there would not be any systematic reason to expect most of the people to lie in the same direction. Because there's no reason to expect that (a) people will not have a consistent motivation to misrepresent the truth, and (b) people will clearly know whether their own depression got better or not, then there's no reason to conclude that "self-reported" data would pose a liability in any way. Furthermore, with something such as depression, it's unclear what measure you would use instead of self-report. It's not as if there's a particular brain scan they can do to prove someone is depressed. There's really nothing that can be objectively measured and analyzed. The only way anyone finds out that a person is depressed is by talking to him. This is fundamentally why (B) is wrong. Understanding why (C) is correct depends on understanding the details of the placebo effect . It might be worthwhile to find a psychology textbook and read a detailed description of this phenomenon. Sugar pills are standard placebos --- they are perfectly safe, and they have absolutely no medicinal value. They don't cure anything. Nobody thinks that sugar pills really are effective in treating anything --- that's precisely the flaw of the argument, and it would be completely ridiculous if an educated person seriously took this position. The placebo effect is all about the ability of the body to generate healing effects purely based on belief and trust in a medical figure, apart from any medicinal value of anything you ingest. In this experiment, the folks in the "control group" received sugar pills, placebos, but the doctor giving it to them didn't say, "this is a sugar pill" --- rather, the doctor said, "This pill will help your depression", and the subject, hearing that assurance from a medical profession, experienced healing effects in her body purely because of the trust she felt in the doctor. The belief, the trust, caused the improvement, and the content of the pills, sugar, was 100% irrelevant. This is the placebo effect. This is a standard effect, widespread in medical testing, and very well documented. Again, this is a difficult idea to grasp from a brief explanation: you may well have to read articles about the placebo effect before you fully understand it. As you may imagine, the placebo effect poses great challenges to medical research --- if some people get better when you give them almost anything, how can you tell that a medicine actually works? In practice, we can conclude that a medicine works only if it significantly outperforms the placebo effect ---- say, 40% of folks who get the placebo get better, and 90% of folks who get the medicine get better --- that would be a medicine that is accepted as valid because it significantly outperformed the placebo effect. Accommodating this issue involves a experimental design called "double-blind" experiments. You can find all of this explained in detail in a good psychology text or a good statistics book. Theoretically, you don't need know outside knowledge to answer GMAT CR, but you need to know the basics of how the world works. It is conceivable that, like this problem, a problem on the real GMAT could spell everything out but, in a way, expect you to have familiarity with the basics of the placebo effect. Arguably, it has implication for how advertising works, and in that sense, it may be highly relevant to what you need to know for your career some day. I would argue: it something every educated person should understand. Does all this make sense? Mike :-)

akashb106 · Answer

Hi Mike,

I could eliminate A D and E but got stuck between B and C. I am not quite sure how we can chose C over B. Because B states that the results were self-recorded instead of some experts recording their findings. So basically it was the patients themselves who were recording how they were feeling. Well ofcourse this will not be accurate and hence damages the argument.

I crossed out C because that the improvement was happening because the patients thought they were taking ADD meds. But now that they know they were taking sugar pills wouldn't that make the patients believe that sugar pills are equally effective and make them chose sugar pills over the ADD expensive meds. I mean the public who reads the findings and sees that sugar pills are equally beneficial to ADD meds.

Can you please advise where my reasoning is flawed and how is C a better choice than B.

Thanks

avohden · Answer

Official Explanation

Answer C -   If, indeed, it were true that "the improvements in mood were primarily attributable to" the patients' continued belief that they were taking antidepressants, it would follow that disabusing patients of this misconception would also strip them of the corresponding placebo effect benefits.

https://d3scmz9sa6n2x2.cloudfront.net/images/newlogo.jpg

amar87 · Answer

This question seems to rely too much on the fact that people know about medical trials :evil:

mikemcgarry · Answer

Dear romancer , I would say that this issue, medical trials & the placebo effect, is right on the boundary between general knowledge and specialized knowledge. The GMAT doesn't demand specialized knowledge of specific issues treated in Verbal questions, but it does expect test-takers to know the general knowledge that anyone who reads the news regularly would know. Are medical trials & the placebo effect too specialized? Hmmm. This is a topic that's in the new a lot, and many intelligent folks have come across these ideas. What's particular tricky about the placebo effect --- the GMAT will explicitly tell you the facts you need ----- here, the fact that people derived a benefit from sugar pills ---- but the test-taker will be left to sort out all the implications of this difficult idea, and having a bit of a background with the placebo effect can help you a great deal. Here's a series of articles I have written about real-world basics that everyone should know and that could really provide valuable background in interpreting a GMAT verbal question: https://magoosh.com/gmat/2012/gmat-supply-and-demand/ https://magoosh.com/gmat/2012/gmat-labor-and-wages/ https://magoosh.com/gmat/2012/inflation- ... -the-gmat/ https://magoosh.com/gmat/2012/beyond-any ... -the-gmat/ https://magoosh.com/gmat/2012/statistica ... -the-gmat/ https://magoosh.com/gmat/2013/profit-and ... -the-gmat/ In a month or so, another article in this series about the placebo effect will be published. I hope this helps. Mike :-)

amar87 · Answer

Yes no doubt, GK always helps. Just mumbling out loud my grievances... thanks for the links though! Btw, out of curiosity, are on the GMAT team that designs questions? :-D

mikemcgarry · Answer

Dear romancer , Your last question was a little hard to understand because it lacked a subject. Did you mean to ask: am I on the GMAT team that designs questions? Most certainly not. I work for a private company, Magoosh. I have spent a great deal of time studying the questions that the GMAT writes, and attempting to create questions of my own that model the kinds of things that the GMAT asks. So, yes, I have written hundreds of GMAT-like questions, many of which (I would like to think) would be worthy of the GMAT's standards, but I have never worked for GMAC and, to the best of my knowledge, nothing of my own creation has ever been incorporated onto the GMAT. Mike :-)

ronr34 · Answer

Hi Mike.

I know about the placebo effect, and when I read this again and again I get confused.
The text states that an equal number of people who took the real FDA approved drugs and of those who took sugar pills
got better.
This finding should be published, to say that the FDA approved drugs do not actually work (as per the placebo test)...
And thus, people should not pay more for them....
I got a little mixed up.
I would appreciate if you could straighten it out for me.

mikemcgarry · Answer

Dear Ronr34 , I'm happy to help. :-)

Here's the prompt again. 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. First of all, here's what I'll say. In all GMAT CR arguments, and most especially arguments in which we are finding a weakness or a flaw, think of the voice of the narrator of the argument as a "character" created by the question writer. In this particular question, I am sure that the person who really wrote this question understands the placebo effect very well, but in writing the question that author has created a voice, a character, the person making the argument, and this character doesn't understand the placebo effect at all. Do not assume that the voice in a GMAT CR arguments speaks with truth, insight, and the authority of the GMAT itself. The voice in the argument is often some fictional character with an incorrect understanding, and finding the flaw means finding the flaw in this character's poor thinking. The first sentence of the argument says that the FDA-approved medicine worked just as well as the placebos. You and I and the author of this question all understand perfectly well: this means the FDA-approved medicine is worthless --- it can't even outperform the placebo effect. That's the intelligent and well-informed conclusion. We understand this, but the "narrator" of the question does not understand that. As we come to understand as we read the argument, the narrator is laboring under the misapprehension that if sugar pills work as well as the FDA-approved antidepressants, then this means that sugar pills must be effective in fighting depression. In other words, because they narrator doesn't understand the placebo effect at all, he assumes that the results from the sugar pills constitutes solid evidence that sugar pills are an effective treatment for depression. The narrator is drawing the conclusion that someone would draw if they had absolutely no idea that there existed something called the "placebo effect." Right there, that's the core flaw in the narrator's thinking. Does all this make sense? Mike :-)

TGC · Answer

Appreciate your response. However, I am not sure well enough if (C) targets sugar pills and not the FDA's.

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

In fact, if you see the stimulus you will come to know the phrase 'prescription antidepressants' is used for FDA's rather than for sugar pills.

' only limited coverage for prescriptions of antidepressant ' This phrase talked about FDA's

mikemcgarry · Answer

Dear TGC, I think the logic of this question would make more sense to you if you understood the placebo effect in general. This is something that shows up frequently enough in medical tests that are discussed in the news that the GMAT could expect you to have some familiarity with it. Here's a blog that provides some background: https://magoosh.com/gmat/2013/medical-tr ... reasoning/ I hope this helps. Mike :-)

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.

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 :-)

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)

Editorial: In a compelling preponderance of clinical trials, patients

Prep Toolkit

Top 5 GMAT Debrief Videos

615 to 715 in 15 Days (Ria's Strategies)

More than Quant/Verbal Abilities: Speed vs. Accuracy

745 with Only Self-Prep and GMAT Club

From 555 to 765: 210-point Improvement

Perfect 805 Score Debrief by Julia

My Rewards

GMAT Critical Reasoning (CR) Questions

Editorial: In a compelling preponderance of clinical trials, patients

Prep Toolkit

615 to 715 in 15 Days (Ria's Strategies)

More than Quant/Verbal Abilities: Speed vs. Accuracy

745 with Only Self-Prep and GMAT Club

From 555 to 765: 210-point Improvement

Perfect 805 Score Debrief by Julia

My Rewards