We have written extensively about the surprising effectiveness of placebos. There is considerable evidence that, at least for certain afflictions, the belief that you’ve been given a powerful drug can have positive health benefits, even if you haven’t been treated at all.
Now, a new study suggests this effect is apparently enhanced when patients are falsely told the “drug” they are getting is unusually expensive.
The results suggest that, on a conscious or unconscious level, many of us carry the assumption that a costly pharmaceutical is more likely to be effective. And at least in some cases, our minds and bodies respond accordingly.
If the belief that expensive drugs are more likely to work than cheap ones is, to some extent, a self-fulfilling prophecy, the case for less-expensive alternative treatments becomes much harder to argue.
Previous studies have shown that Parkinson’s disease—which is the result of the death of certain dopamine-generating cells in the brain—is receptive to placebos. A standard treatment is levodopa, a synthetic substance that is converted in the brain to dopamine. When patients are informed that they are receiving a dose of the drug—or, better yet, a more expensive alternative—their brains often respond to feelings of “heightened expectation and positive anticipation” by (you guessed it) releasing dopamine.
In the journal Neurology, a research team led by Dr. Alberto Espay of the University of Cincinnati describes a small-scale study of 12 people with moderate to severe Parkinson’s disease. On their first visit, all were given their standard medication; after it took effect, their motor skills were assessed to determine the degree to which the medicine had helped them.
Their second visit, which occurred within a week of the first, was more complicated. Participants were told they would be trying two new drugs: one “cheap” ($100 per dose) and the other “expensive” ($1,500 per dose). In fact, they were simply injected with saline solution.
Half received the faux expensive drug first, followed by the faux cheap drug four hours later. Before and after each injection, their motor skills were tested, and their brain activity was measured using fMRI technology.
The key result: “A larger motor benefit was achieved by a ‘costlier’ intervention, particularly when given first,” the researchers write. Specifically, they found a nine percent greater overall improvement with the “expensive” placebo compared to the cheap one—a difference that rose to 14 percent when the “expensive” one was given first.
Of course, higher dopamine levels are not the answer to every disease. Still, these are fascinating findings, and they offer a mixed message to policymakers. It provides further confirmation that placebos, which cost very little, can under certain circumstances produce significant health benefits.
On the other hand, if the belief that expensive drugs are more likely to work than cheap ones is, to some extent, a self-fulfilling prophecy, the case for less-expensive alternative treatments becomes much harder to argue. That’s very bad news for administrators trying to keep costs down.
Then there are the ethical issues involved. Most doctors would probably consider it unethical to deceive a patient about the drug he or she is receiving—but what if such a false belief produces better results? (Espay and his colleagues note that some preliminary research has found placebos can work even when patients are aware they are placebos.)
While these are tricky questions, the researchers are encouraged by their results. They point to “the potentially large benefit” of placebos, which could be used “to maximize benefits while reducing (drug) dosage and toxicity.”
Indeed, if the brain can be primed to produce beneficial chemicals, why would you not incorporate that helpful response into a treatment plan?