Wednesday, March 05, 2008
Comes word of a recent study of the placebo effect: you get what you pay for. In the recent Journal of the American Medical Association, it's reported that when people are given two placebo pills for pain, the more expensive one is the more effective. From a summary in the NY Times:
"The investigators had 82 men and women rate the pain caused by electric shocks applied to their wrist, before and after taking a pill. Half the participants had read that the pill, described as a newly approved prescription pain reliever, was regularly priced at $2.50 per dose. The other half read that it had been discounted to 10 cents. In fact, both were dummy pills. The pills had a strong placebo effect in both groups. But 85 percent of those using the expensive pills reported significant pain relief, compared with 61 percent on the cheaper pills. The investigators corrected for each person’s individual level of pain tolerance.
From another report on the study, on the WSJ Health Blog:
"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. While he has no proof, Berns tells the Health Blog that he thinks pharmaceutical companies take such expectation into account when they set prices for their medicines."
When the issues are such things as pain or coping with chronic disease, expectation + therapy = outcome. And expectations are heavily weighted by various preconceptions. In the military I happily handed out a big honkin' green and octagonal pill for back pain. I'm sure it was no more effective than aspirin; but when people took a look at those things, they had to figure it was the real deal. It also helped, I think, that I wrote "NO REFILL!!" on the prescription and underlined it a couple of times. As interesting as it is, it's also a little sad to realize how easily manipulable our brains are. (Which, it must be said in these political times, applies way beyond the medical...)
Consciously or not, I think all physicians make use of these para-placebo effects -- maybe, in fact, we should do so more. After all, it's clearly what gives "alternative" and "complementary" mumbo their jumbo. Make a few bucks wherever you can find them. And if it improves response, better still.