Costly placebo works better than cheap one

Mar 04, 2008

A 10-cent pill doesn't kill pain as well as a $2.50 pill, even when they are identical placebos, according to a provocative study by Dan Ariely, a behavioral economist at Duke University.

"Physicians want to think it's the medicine and not their enthusiasm about a particular drug that makes a drug more therapeutically effective, but now we really have to worry about the nuances of interaction between patients and physicians," said Ariely, whose findings appear as a letter in the March 5 edition of the Journal of the American Medical Association.

Ariely and a team of collaborators at the Massachusetts Institute of Technology used a standard protocol for administering light electric shock to participants’ wrists to measure their subjective rating of pain. The 82 study subjects were tested before getting the placebo and after. Half the participants were given a brochure describing the pill as a newly-approved pain-killer which cost $2.50 per dose and half were given a brochure describing it as marked down to 10 cents, without saying why.

In the full-price group, 85 percent of subjects experienced a reduction in pain after taking the placebo. In the low-price group, 61 percent said the pain was less.

The finding, from a relatively small and simplified experiment, points to a host of larger questions, Ariely said.

The results fit with existing data about how people perceive quality and how they anticipate therapeutic effects, he said. But what's interesting is the combination of the price-sensitive consumer expectation with the well-known placebo effect of being told a pill works. "The placebo effect is one of the most fascinating, least harnessed forces in the universe," Ariely said.

Ariely wonders if prescription medications should offer cues from packaging, rather than coming in indistinguishable brown bottles. "And how do we give people cheaper medication, or a generic, without them thinking it won't work"" he asks.

At the very least, doctors should be able to use their enthusiasm for a medication as part of the therapy, Ariely said. "They have a huge potential to use these quality cues to be more effective."

Source: Duke University

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User comments : 3

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AJW
4 / 5 (1) Mar 05, 2008
Since patient reported pain is
subjective and not a measured value, one
may not say there is a reduction in actual
pain. Rather than reduced pain, the
placebo effect may be seen as an
exhibition of patient pleasing physician.
Humans are raised to please their
parents. This response is overlaid onto
other authority figures later in life.
All of education is based on a student
proving teacher with a correct answer.
The answer%u2019s correctness is judged by
the teacher.
HarryStottle
3 / 5 (1) Mar 05, 2008
The placebo effect is real. It is certainly not a matter a merely patient pleasing doctor or authority figures. I am confident that well designed protocols can and do filter that factor out of the equation.

The big problem with the placebo effect is that it requires deception. No patient is ever going to run into their doctor demanding their most effective placebo...

Are we saying that we must allow deception into something as critical as healthcare on the grounds that it's extremely cost effective?

So is theft, if you don't get caught...
mirosurabu
not rated yet Mar 06, 2008
I am curious how someone can filter out an effect of suggestion (information) on process of judgment.

The matter is not the existence of placebo effect, but instead what is behind it and what kind of effect a simple suggestion can have.