You Get What You Pay For? Costly Placebo Works Better Than Cheap One

Science Daily ^ | 3-5-2008 | Duke University

[blam]

You Get What You Pay For? Costly Placebo Works Better Than Cheap One

ScienceDaily (Mar. 5, 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."

The study was funded by MIT.

Adapted from materials provided by Duke University, via EurekAlert!, a service of AAAS.

[SoldierDad]

Evidence that some people’s pain is all in their head.

[yefragetuwrabrumuy]

Pain has lots of twists and turns.

To begin with, several alternative forms of medicine are about 85% effective in the general public. But a different group of about 15% of people are not satisfied with each one.

That is, if you consider acupuncture as a complete form of medicine, about 15% of people are unresponsive to it. For western pharmacopoeia, a different group of people, but again, about 15%, aren’t satisfied by it.

Second, pain varies by the differences in the number and quality of nerves in the affected area, which varies between people. An excellent example is the differences between people who eat hot peppers.

Third, pain also varies by age, with younger people generally more sensitive to pain than older ones.

Fourth, acute and chronic pain have been discovered to have different cell pathways to the brain through the spinal cord. This has resulted in the development of drugs that just inhibit the action of the chronic pain signal cells.

Fifth, there is great variance in the amount of endorphines, the bodies natural pain killers, that people produce. Because heroin addicts shut off most of their endorphine production with their drug, when they quit, it usually remains below normal levels, making them sensitive to pain and other stimulation.

This is probably where placebos get their effect, by fooling someone to expect their pain to be relived, so that they produce more endorphines.

So what this research has discovered that in addition to the psychology of placebos, there is also a psychological factor as to the quality of the placebo.

Then again, people regularly buy $20 sunglasses priced at $200, and labeled “designer”.

[glorgau]

I’ve done fine using CZ instead of diamonds.

[TChad]

I doubt that this study would surprise many 19th century physicians. Nor would it surprise them to learn that placebos that tasted terrible were more effective than those that tasted good.

These days, most medicines actually work, but that was not always the case. In the bad old days, placebos were a much more important part of a physician's pharmacopoeia.