'Expensive' Placebos Work Better Than 'Cheap' Ones

March 4, 2008— -- The more expensive your pain medications are, the better the relief you get from taking them — even if they're fake.

That's according to a study published this week in the Journal of the American Medical Association, which suggests that sugar pills labeled as expensive drugs relieve pain better than sugar pills labeled as discounted drugs.

Researchers often compare real drugs to sugar pills in medical studies to account for the placebo effect, in which the illusion of taking medicine alone can cause symptoms to disappear.

But Dan Ariely, a behavioral economist at Duke University in Durham, N.C., and a team of collaborators from the Massachusetts Institute of Technology compared the placebo effect of the marketing that people are asked to swallow along with their medicine.

In the study, 82 volunteers were subjected to a series of electric shocks — a standard research protocol for measuring pain thresholds. They were then given a placebo pill alongside a fake drug company brochure for the fictitious drug "Veladone-Rx," — ostensibly a new fast-acting painkiller made in China.

The only catch was that half of the test subjects received brochures showing that the drug had been marked down from the original price of $2.50 a pill to 10 cents a pill. These modified brochures also included circled fine print which suggested that the pills were manufactured in China.

After participants went through the shocks again, 85 percent in the full-price group reported pain relief from their sugar pill, while only 61 percent in the discount group reported pain relief.

Placebos Make Good Medicine

"In a way, placebo is a big part of medicine," said Ariely, who wrote an entire book on the subject called "Predictably Irrational."

The placebo effect goes beyond simple perception. In fact, people taking placebos for pain relief will secrete higher levels of the body's natural painkillers called endogenous opioids, said Ariely.

"But the interesting thing is, we can't close our eyes and say, 'please can I get some pain relief?'" said Ariely. "It's under our control, but not under our control consciously."

The placebo effect is so powerful, it can help 25-50 percent of patients with migraines, said Dr. Timothy A. Collins, associate clinical professor of neurology at Duke University Medical Center.

"It can even help with unexpected medical conditions such as with the skin disorder psoriasis, which has a 27 percent favorable placebo rate for patients, or a 16 percent placebo rate with Parkinson's disease."

But while many doctors are quite aware of the placebo effect, some may not be aware of all the elements that go into it — including the price of the pill, the drug ads on TV, or even the physician's attitude towards the drug, said Ariely.

Get What You Pay For, or Buyer Beware?

A common reason to go after a brand-name drug is the popular saying "you get what you pay for."

"It's true with cars, it's true with other consumables," said Dr. Nortin Hadler, professor of medicine at the University of North Carolina at Chapel Hill. "If you buy a lemon and drive it home, you're going to know in a hurry.

"But when it comes to health care issues, you don't know it in a hurry — you don't know," Hadler said.

Dr. Carmen Green, director of Pain Medicine Research at the University of Michigan Health System, has frequently experienced this phenomenon in her practice.

"Patients come in and say, I saw this on TV and this is what I want," said Green. "But often there are other drugs that are available that are cheaper, or should be tried first."

Besides occasionally annoying doctors, the drive towards more expensive drugs might have costs that go beyond the pockets of people watching drug ads.

"We're all paying for higher health care costs, whether you have government insurance or private insurance," said Green.

Yet, not all is doom and gloom. Ariely and Hadler believe doctors can turn the placebo effect around for the advantage of both the doctor and the patient.

Office Visit: Expanding Placebo

"It really puts a new twist on how we think about reality," said Ariely, who questioned how price and marketing affects the potency of drugs given out in free packets, drugs given in discount rates, or even drugs that come in boring bottles.

For Hadler, the study might convince doctors to develop their own positive marketing for a treatment.

In his own studies, Hadler has found that the way a physician describes a drug can change how much a patient will follow through with a treatment regimen.

"Compliance goes down when you go through all the side effects listed for the drug," said Hadler. "But if you say, 'This is the best thing ever, side effects are rare,' people will respond positively."