One for those who can't start the day without a caffeine hit. ;-)

In 2005, global pharmaceutical sales totalled US$602 billion with growth of 7% from the previous year.
At an average annual growth rate of 14% between 1994 and 2003, pharmaceuticals top the OECD manufacturing trade growth stats, ahead of coke, refined petroleum products and nuclear fuel (8%), medical, precision and optical equipment (7.5%), aircraft and spacecraft (7.4%), and motor vehicles, trailers and semi-trailers (7.3%).
In 2006 the 10 largest pharmaceuticals firms accounted for 46 per cent of global sales.

Ref. Medicines Australia

Want to know where we get the 'up to 70% success' claim in our packaging?

"The placebo response, noted as an early or nonpersistent improvement in response to an inactive agent, represents one of the most significant challenges in central nervous system (CNS) drug development. Despite a wealth of documentation, there is no commonly accepted definition of this phenomenon. However, it is agreed that there has been a significant increase in the placebo response in the last 20 years, particularly in clinical trials with antidepressant medications for major depressive disorder (MDD).

Estimates as high as 70% have been reported for CNS clinical trials. (our italics) Such large placebo rates have a significant impact on the cost and speed of drug development.

Since fewer than half of the depressed patients who receive active medications in psychiatric trials show clinically significant improvement, some critics claim that antidepressants are no better than placebo treatment, and their illusory superiority depends on poorly designed studies and biased clinical evaluations. In a set of six identically designed, three-arm, parallel controlled trials submitted to the Food and Drug Administration for an antidepressant drug, Leber reported that antidepressants could not be distinguished from placebo in five of the six studies."

Ref. Richard Entsuah, Phil Vinall: Potential Predictors of Placebo Response: Lessons From a Large Database, Drug Information Journal. Ambler: 2007. Vol. 41, Iss. 3; pg. 315, 16 pgs

"Academic Physicians Use Placebos in Clinical Practice and Believe in the Mind–Body Connection" - Rachel Sherman and John Hickner (University of Chicago Pritzker School of Medicine), Journal of General Internal Medicine, Volume 23, Number 1 / January, 2008

Abstract

Background - The placebo and the placebo effect are often investigated in the context of clinical trials. Little data exist on the use of placebos in the course of routine health care.

Objective - The aim of this study is to describe a group of academic physicians’ use of placebos and their knowledge, attitudes, and beliefs about placebos and the placebo effect.

Design - A 16-question anonymous web-based survey of physicians from Internal Medicine departments of 3 Chicago-area medical schools was used.

Results - There were 231/466 (50%) physicians who responded; of these, 45% reported they had used a placebo in clinical practice. The most common reasons for placebo use were to calm the patient and as supplemental treatment. Physicians did not widely agree on the definition of a placebo and had a variety of explanations for its mechanism of action. Ninety-six percent of the respondents believed that placebos can have therapeutic effects, and up to 40% of the physicians reported that placebos could benefit patients physiologically for certain health problems. Only 12% of the respondents said that placebo use in routine medical care should be categorically prohibited. Regarding “placebo-like” treatment, 48% of respondents reported giving at least 1 type of treatment in a situation where there was no evidence of clinical efficacy.

Conclusion - Nearly half of the respondents use placebos in clinical practice and most believe in the mind–body connection. The results of this study, based on retrospective self-reported behavior, are subject to recall bias and may not be representative of American physicians.

Interesting talk on the Australian Broadcasting Commission 'Ockhams'Razor' radio program about the marketing of (legal) drugs by big pharma through the medical establishment. The speaker is Professor Christopher Norden, from Adelaide Hospital and the Institute of Medical and Veterinary Sciences. He talks of his own experience of the many incentives offered to practitioners by pharmaceutical companies to prescribe their wares.

From Professor Norden's talk:

"It is about a hundred years since that great Canadian-born physician Sir William Osler, Regius Professor of Medicine in Oxford, complained about the increasing influence of the pharmaceutical industry on the medical profession. If he knew how this influence had increased since then, he would be turning in his grave at the way the industry now dominates doctors' prescribing habits. It does this not only by direct and indirect pressure on the doctors themselves, but also by encouraging the public to ask for scripts and to demand that governments provide the money."

Ref. Ockham's Razor, 14 October, 2007 <a href="http://www.abc.net.au/rn/ockhamsrazor/stories/2007/2056879.htm" title="http://www.abc.net.au/rn/ockhamsrazor/stories/2007/2056879.htm">http://www.abc.net.au/rn/ockhamsrazor/stories/2007/2056879.htm</a>

The online skeptic Robert Todd Carroll accepts that there is a placebo effect, but has concerns that administration of a placebo is superfluous at best.

(To) those who say "what difference does it make why something works, as long as it seems to work" I reply that it is likely that there is something which works even better, something for the other two-thirds or one-half of humanity who, for whatever reason, cannot be cured or helped by placebos or spontaneous healing or natural regression of their pain. (1)

He assumes, though, that a placebo is given or administered in place of another therapy. If the sophisticated plumbing that is modern surgery is the best way to fix a problem, not many people would argue that administration of a sugar pill is a better course of action. But if the sugar pill engages a positive somatic response, say in the alleviation of pain, and if it is pharmacologically inert and (save perhaps in the case of diabetes) harmless, if in fact it is pleasing to the patient, who can say it should be withheld?

Whichever way we cut the arguments and the theories, the placebo effect is real and it is real because it engages those parts of human beings which defy reduction to the mechanical. It is real because it therapeutically engages human capacities and capabilities for which conventional medicine has only approximations and crude theorization, if not actual distrust. It may work in what to many are the scientific borderlands, but the important thing for us is that it works.
"The placebo effect can occur," as the physician Herbert Spiegel once put it, "when conditions are optimal for hope, faith, trust and love."

It might sound sentimental, but then sentiment, working hand in hand with science, can make medical practice so much more powerful. A world in which placebo -- preferably in the form of deft encouragement, but sometimes in the form of a harmless pill -- was tolerated, even embraced, would be a world in which doctors never forgot that medical practice consists not only of the technologies of diagnosis and treatment but also of the careful tending of a patient's expectations and the unabashed willingness to comfort. (2)

Refs
(1) Robert Todd Carroll, Placebo Effect (The Skeptics Dictionary), http://skepdic.com/placebo.html, accessed 12 January 2007
(2) Margaret Talbot, The Placebo Prescription, New York Times Magazine, September 2001, http://www.nytimes.com/library/magazine/home/20000109mag-talbot7.html, accessed 1 July 2007