When it comes to painkillers, many people believe “you get what you pay for,” according to a new study that found patients are actually more likely to get relief if they think they’re taking high-priced pain pills.
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Volunteers who were given a placebo said to cost $2.50 per pill and described as a “potent opioid-agonist that provides fast-acting, long lasting relief” were much more likely to report pain relief than those given a placebo described as a discounted ten-cent version of the same pill. The study is published as a research letter in this week's Journal of the American Medical Association.
“Placebos work because people expect them to,” said Dan Ariely, the corresponding author of the paper, a professor of behavioral economics at the Massachusetts Institute of Technology in Cambridge. “The interesting thing is that once you have a discounted price, it basically cuts people’s expectations. They don’t expect it to be as good, and then it might actually not be as good.”
The study, carried out in Boston, included 82 paid volunteers. All of the volunteers were told about a new drug that had recently been approved by the Food and Drug Administration, but half were told the drug was regularly priced, while the other half were told it had been discounted.
The volunteers were then administered a series of mild electrical shocks that were calibrated to their individual level of pain tolerance. The shocks were administered before the volunteers took the pills and again afterward, and the changes in the subjects’ responses were recorded.
‘Expectations are key’
Although the pills were actually placebos consisting of no more than vitamin C, 85 percent of the volunteers who thought they were taking the higher priced painkillers experienced a reduction in pain, compared with only 61 percent of those taking what they thought were discounted pills.
“Expectations are key,” when it comes to the placebo effect, said Ariely, author of "Predictably Irrational:The Hidden Forces That Shape Our Decisions."
The study underscores how powerful the placebo effect is, but also helps explain why patients may be dissatisfied with cheaper generic drugs, even though they are equivalent to the branded medications they replace, said Dr. Adriane Fugh-Berman, an associate professor at Georgetown University School of Medicine and the principal investigator of PharmedOut, a project that educates physicians about the influence pharmaceutical companies have on prescribing.
“Expectations are manipulated by manufacturers, and drug companies are coming up with all kinds of strategies to convince consumers that it’s worth it to pay more for higher priced drugs,” said Fugh-Berman. “If you’re expecting a medication to work, or if your health care practitioner increases that expectation in you, it may work better for you, at least for symptoms like pain, which are very responsive to placebo.”
More than triple the cost
The average cost of a prescriptionfor a brand medication is $111.02, compared to $32.23 for a generic prescription, according to the National Association of Chain Drug Stores.
The study also demonstrates that the placebo effect can be modulated depending on how the placebo is presented, said Ted Kaptchuk, an associate professor of medicine at Harvard Medical School, who has studied the placebo effect.
“How you package the experience and how you dress it up leads people to expect different outcomes, and those outcomes become embedded in human biology,” Kaptchuk said. He added, “This is just more evidence that the experience of illness is not only a biological event. Our beliefs, our imagination, our expectations, the environmental cues we receive all contribute to how we experience illness and health.”
Roni Caryn Rabin is a health writer who lives in New York City. She has written for The New York Times, The Washington Post, Newsday and Real Simple magazine, among other publications, and is author of the book, "Six Parts Love: A Family's Battle with Lou Gehrig's Disease." She teaches journalism at the Columbia University Graduate School of Journalism.
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