Placebos can be powerful things, whether they come wrapped in a nicely colored box, or take the form of an enthusiastic clinician.
Dan Ariely, a behavioral economist at Duke University, and author of the excellent new book Predictably Irrational has written a letter in this week’s issue of the Journal of the American Medical Association in which he suggests that pill costing ten cents is not as effective at preventing pain as a $2.50 pill, even when they are identical placebos.
Ariely and a team of collaborators at the Massachusetts Institute of Technology recruited 82 people to participate in a study in which light electric shocks were administered 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 painkiller that cost $2.50 per dose. The other half was 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.
Although simple and small, the experiment raises some large questions.
As Dr. Ariely says,
"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.”
The results are consistent with previous data about how people perceive quality and how they anticipate therapeutic effects. What is interesting here is the combination of the price-sensitive consumer expectation with the placebo effect of being told that a pill works.
Would it help if prescription medications offer cues from packaging, rather than coming in indistinguishable brown bottles?
Is there a way of giving people cheaper or generic medications without them thinking they will not work?
As Dr Ariely says,
“At the very least, doctors should be able to use their enthusiasm for a medication as part of the therapy. They have a huge potential to use these quality cues to be more effective."
“It requires a great deal of faith for a man to be cured by his own placebos.”
--John L. McClenahan (American Physician and Writer, 1935-)
“Your thoughts are like the seeds you plant in your garden. Your beliefs are like the soil in which you plant these seeds.”
--Louise Hay (American Spiritual Teacher, 1927-)
“Change your beliefs and you change your destiny.”
--Sterling Welling Sill (Elder of the Church of Jesus Christ of Latter Day Saints, 1903-1994)