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Study: Price tags contribute to placebo effect
Pills labeled more expensive expected to work better
The Baltimore Sun

    For years, experts have known that placebos — fake injections and pills with no real medication — can improve the health of people with pain, asthma, high blood pressure and angina.
    Now, they’ve learned that raising the price of a fake pill can make it work even better.
    A report last week in the Journal of the American Medical Association shows that expectations — shaped by factors that include the price of a medication — play a key role in how we respond to pain relievers as well our response to therapies for depression, cancer, strokes or heart attacks.
    The latest report adds to a store of knowledge about placebos, a subject that has long fascinated scientists. Understanding placebos could unravel mysteries about the body’s ability to heal itself, they say.
    Experts do know one reason placebos work: They raise expectations. Make someone believe that a tablet will make a headache disappear and it often does — even if it turns out to be a sugar pill.
    “Expectations create a different reality for us, which we don’t really appreciate,” said Dan Ariely, a behavioral economist at Duke University.
    Researchers typically use placebos as controls in clinical trials of medicines and other therapies. Some volunteers get the real drug, while others get identical-looking placebos. It’s not unusual for placebos to work almost as well, and in some cases better, than the drugs being tested.
    In the latest study, Ariely ap- plied electric shocks to the wrists of 80 volunteers before and after giving each one a placebo painkiller. He told half of the subjects that the pills cost $2.50 each and the other half that they cost 10 cents apiece.
    About 60 percent of the 10-cent group reported pain reduction from the placebo, compared with 85 percent of the $2.50 group. None of the test subjects, who received $30 for their trouble, actually received a painkiller.
    “It says something about our expectations and how they shape reality,” Ariely said. “Price is just one of the things we use to make inferences.”
    Experts say the results also show the importance of boosting the hopes of patients treated for a variety of ailments.
    “Our response to any intervention is partly the result of the power of the intervention and partly the result of our expectations going in,” said Alan Bellack, a professor of psychiatry at the University of Maryland School of Medicine.
CONFIDENCE IS KEY
    Placebos have improved outcomes in studies of chronic pain, anxiety, high blood pressure, angina, asthma, ulcers, Parkinson’s disease and rheumatoid arthritis, said Irving Kirsch, a psychologist who studies placebos at the University of Hull in England.
    Kirsch reviewed 35 clinical trials of antidepressants, submitted by drug companies to the Food and Drug Administration, and found that placebos did just as well as the real drug with moderately depressed patients.
    The review, published in February in the Public Library of Science, also found only a small, “clinically insignificant difference” between placebos and the real drugs among patients who were severely depressed. Even so, Kirsch said that patients on antidepressants should talk to their doctors before stopping them.
    So how do placebos work their magic? Researchers have known for years that they trigger a biochemical response in the brain, releasing neurotransmitters such as dopamine that act as natural painkillers. They also know that packaging can enhance the effect.
    If researchers wear white lab coats, talk in a soothing voice or somehow instill confidence in volunteers, the placebo is usually more effective, said Dr. Donald Price, a neuroscientist at the University of Florida who has studied the subject for 30 years.
    But Ariely’s study is the first to show that a higher price might enhance a placebo’s effect.
    “This applies in a very broad way to human beings in a variety of settings,” Price said. “It doesn’t just apply to medicine. It’s sort of a ubiquitous principle.”
    The pricing effect also might explain the reaction of 20 students at the California Institute of Technology who had their brains scanned while sipping wine they were told cost either $90 a bottle or $5 a bottle. When they thought they were sipping the expensive stuff, the scans showed increased activation of the brain’s pleasure center — even when they were actually sipping the $5 wine.
    “A lower price creates an expectation of inferiority,” said Hilke Plassmann, the neuroeconomics researcher at Caltech who led the study.
    “The expectation is a crucial part of an outcome.”

It just goes to prove that medicine is NOT always the answer!