It’s not just your bank balance that pricey drugs can affect. In a new study reported in Science Mag, the results suggest that people taking what they think is an expensive medicine tend to experience much worse side effects that those who think they are using a bargain-basement alternative.
Most of us are familiar with the placebo effect – the idea that fake treatments can produce beneficial responses in people – but there’s also another side to this phenomenon. This flipside is called the nocebo effect, and it usually means that a person experiences a negative response to a fake treatment just because they’ve been told that the fake drug may cause side effects.
In this study, two groups of people were given a fake anti-itching cream and were told that it may cause increased skin sensitivity. The first group were given the cream in an expensive-looking blue box labelled with a fake brand name.
The other group was given the cream in a drab-looking box labelled with a generic drug name. After testing the cream – which was the same in both boxes – the group that tried the expensive-looking cream reported much higher levels of skin sensitivity. The expensive group showed a pain increase of almost 30% while the cheap group experienced a pain increase of 3.4% compared to people that hadn’t seen either box.
The researchers also noticed that the areas of the brain that are linked to the placebo effect were more active in those people who tried the expensive cream, suggesting that they really were experiencing greater pain than the other group.
The placebo effect is well documented, but studying the nocebo effect is trickier, says the study’s lead author, Alexandra Tinnermann at The University Medical Center Hamburg-Eppendorf in Germany.
Studies on the nocebo effect invariably involve trying to make people experience pain of some sort, and that can take researchers onto ethically dubious ground.
Knowing more about the placebo and nocebo effects could have important implications for the way that doctors and drug companies present treatments to people. If a person taking a drug knows that it’s expensive, this tends to boost the placebo effect, Tinnermann says, so if a doctor wanted to boost that effect then they might mention a drug’s price when they present it to a patient.
This could be particularly useful in the US, she says, where doctors are more likely to discuss the cost of a treatment with a patient. But Jeremy Howick at the University of Oxford says that the nocebo effect might be even more powerful than the placebo effect.
“From an evolutionary perspective it’s better to remember bad things than good things. Say you’re a caveman and you find an apple that tastes good – you don’t have to remember that necessarily. But if you have an apple that’s poisonous, you better remember it.”
He says that because we’re hardwired to remember things that might cause us harm, we might be more sensitive to the nocebo effect. The reason why we don’t tend to feel a nocebo effect when we take an over-the-counter drug like ibuprofen, for example, might be because most people just don’t read the side effects on the box.
In clinical trials, where volunteers have to be told about side effects, the nocebo effect is much more commonly seen. Howick says that by paying a little more attention to how they present drugs to patients, doctors might be able to boost the health benefits of treatments without changing what the prescribe.
When we hear positive things, he says, our bodies are primed to release chemicals such as dopamine that lessen pain and make us feel more relaxed. “Depending on the words they use it can affect how the patient feels.”
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