Pricey pills work better even when they're fake

[Guest guest]

Pricey pills work better even when they're fake

$2.50 placebo eased more pains than identical 10-cent pill, study

found

By Roni Caryn Rabin

Special to MSNBC

updated 4:00 p.m. ET, Tues., March. 4, 2008

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.

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. e Fugh-Berman, an associate professor at

town 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 prescription for 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.

© 2008 MSNBC Interactive

http://www.msnbc.msn.com/id/23455819/