PLACEBO EFFECT

March 5, 2008

Call it the double-placebo effect.  In a patient study, a placebo pill carrying a $2.50 price tag eased pain much more effectively than an identical pill that patients believe costs just 10 cents.  The results may help explain, among other things, why some patients report worsening symptoms when they switch from a brand-name drug to a cheaper generic version of the same medicine, say researchers at the Massachusetts Institute of Technology.

In the study, healthy volunteers were given a brochure describing a new (and fictional) codeine-like painkiller that had just been approved by the Food and Drug Administration (FDA).  They then were randomly assigned to two groups, one of which was told the pill cost $2.50, the other, without further explanation, that it was discounted to a dime.  Then researchers administered a series of increasingly powerful electrical shocks to the volunteers' wrists until each reached his or her maximum pain tolerance.

Patients then took their pills, which weren't painkillers at all, and rolled up their sleeves to get the jolts and record their impressions a second time.  The results:

  • Of the patients who took the full-price pill, 85 percent said they felt less pain afterward.
  • Of the patients who took the 10 cent pill, 61 percent said they felt less pain afterward.

Not bad on both counts for a drug that isn't supposed to do anything, says the Wall Street Journal.

The better showing by the more costly pill shows that "how you set up people's expectation is crucial" to treatment effect, says Gregory Berns, a neuroscientist at Emory University School of Medicine.

The findings could also shed light on patient compliance with their prescriptions, says principal investigator Dan Ariely.  Shifting to a cheaper generic pill may save money, he says, but he asks: "Can a pill be too cheap so people don't expect it to be good and they don't take it regularly?"

Source: Ron Winslow, "Placebos Might Work Even Better With a Brand Name," Wall Street Journal, March 5, 2008.

For text:

http://blogs.wsj.com/health/2008/03/04/placebos-might-work-even-better-with-a-brand-name/ 

For study abstract:

http://jama.ama-assn.org/cgi/content/extract/299/9/1016 

 

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