Expensive Placebos Work Better Than Cheap Ones
3 CommentsBy Ed Silverman // March 5th, 2008 // 7:44 am
We all know that a higher price may create the impression of higher value. And we know that a placebo can reduce pain as well as a real med. Now, a few researchers have combined both effects and discovered that a $2.50 placebo works better than one that costs a mere 10 cents, according to a study in the latest issue of the Journal of the American Medical Association.*
What’s significant about this? The findings may explain why some patients report that cheaper generics are less effective than brand-name meds, even though the drugs contain the same active ingredients.
The study, which was funded by the Massachusetts Institute of Technology, rated the pain caused by electric shocks given to 82 men and women before and after taking a pill. One group was told they received a placebo that sells for a dime and the other a purportedly new pain reliever that sells for $2.50 each. In truth, both were placebos. Yet, 85 percent of those who received the ‘prescription med’ reported feeling pain relief, compared with just 61 percent of those given the cheap pill.
“It’s all about expectations,” lead researcher Dan Ariely, a behavioral economist at Duke and the author of a new book, ‘Predictably Irrational: The Hidden Forces That Shape Our Decisions,’ tells The New York Times. “When you’re experiencing pain relief, you’re secreting your own opioids. And when you get it on discount, you doubt it, and your body doesn’t react as well.”
“It’s a great finding,” Guy Montgomery, an associate professor of cancer prevention at the Mount Sinai School of Medicine who was not involved in the research, tells the Times. “Their manipulation of price affected expectancies of drug benefit, and pain is the ultimate mind-body phenomenon.”
Previous studies have shown that pill size and color also affect people’s perceptions of effectiveness. In one, people rated black and red capsules as “strongest” and white ones as “weakest,” the Times notes. Other information like the country where the drugs were manufactured can also affect perceptions.
* This is the extract. A subscription, which we have, may be required to read the full text.
Justice in Michigan
This not news, but I think we need to be careful about overstating the link to dissatisfaction with generics. Of course, there is a certain “something” about brand name. And, especially lately, the assumption lingers that more generics are made in places less “kosher.”
Still, given the relatively liberal standards of bioequivalence, issues of fillers and dissolution time, etc., generics are demonstrably problematic in some instances, while in others they may actually be more efficacious.
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Bob Freeman
Over many decades we have known the color of a tablet/capsule adds to the physician’s and patient’s perception of the drug and the illness. For example, one wouldn’t put a “trivial” color on a cancer drug, nor would you put a “somber” color on an antidepressant.
Given that many generics, especially those for drugs not in a commodity status, likely follow the dosage form design of the innovator’s, it may be likely that cost is more important.