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Placebo effect influenced by perceived cost, study finds

Rating

4 Star

Categories

Placebo effect influenced by perceived cost, study finds

Our Review Summary

This story summarizes a study that tested responses to two placebos — one cheap and one expensive — in patients with Parkinson’s disease. The expensive placebo seemed to work better, but the effect was small. The study itself was also tiny — just 12 patients — which is something we think the story should have called more attention to.

 

Why This Matters

This study suggests that, as with hair shampoo, people believe that pricier drugs are better. This is a challenge to attempts to deliver more effective treatments for less money. Better means to communicate drug efficacy may be needed to help offset this effect. We could also potentially harness this effect to develop more effective placebos, which would reduce the need for expensive drug treatments.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The cost of sugar pills is not in question. But the story does explore the cost implications of developing more effective placebos. It says, “To the extent that doctors can use placebos to improve patients’ symptoms, they can use the real drugs less, which may be expensive or toxic.”

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The story quantifies results appropriately. It notes that in one test, “67% of the patients were judged ‘very good’ or having ‘marked improvement’ after they took the expensive placebo, compared with 58% of patients after they took the purportedly cheap placebo.” Readers can tell from the story’s numbers that we’re talking about a relatively modest amount of improvement.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story did not discuss potential harms. From a bioethics standpoint, there is concern that the use of a placebo without the patient’s knowledge may undermine trust between the physician and patient, thereby leading to medical harm. (More background on these concerns in this Science-Based Medicine post.) In addition, patients receiving placebo treatments in clinical studies commonly complain of adverse drug reactions. The story also could have discussed the potential for harm resulting from the participants’ interruption of active drug therapy for the study.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

While the mechanics of the study are nicely described, a sample size of only 12 patients is far too small to draw definitive conclusions. The story never cautions readers about this very important limitation.

Does the story commit disease-mongering?

Satisfactory

The story does not exaggerate the burden of Parkinson’s or other diseases.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story ends with a quote from an accompanying editorial by experts not affiliated with the study. Although the quote in question doesn’t really add to our understanding of the results — it merely reinforces the study authors’s conclusions — we’ll rate this as satisfactory. We would ideally have liked for the story to have interviewed an expert, or at least called attention to comments from the editorial that provide some critical analysis of the results.

Does the story compare the new approach with existing alternatives?

Satisfactory

The study itself was a comparison of two different placebos — one cheap, the other expensive. The story makes this clear.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The availability of sugar pills is not in question. However, many physicians would not consider it ethical to prescribe a placebo. The story does not convey this nuance.

Does the story establish the true novelty of the approach?

Satisfactory

The story establishes that the placebo effect has been around for quite some time and that many studies have explored this effect in Parkinson’s disease. The new study looked at how the perceived cost of the placebo treatment would affect its efficacy. The story explains this.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story quotes from an accompanying editorial, so we can be sure that it went beyond this news release issued by the University of Cincinnati.

Total Score: 7 of 10 Satisfactory

Comments (1)

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Alberto Espay, MD

February 4, 2015 at 3:06 pm

I appreciate this review of the news story, which I think it is a fair assessment. As the study’s author, I would make these points:

(1) Given the ethical challenges of this research, more patients were not allowed by the IRB. It is remarkable, however, that with such small numbers the differences were statistically significant. With greater numbers, the magnitude of statistical significance would have increased, not decreased, so technically, more patients would not have changed the story or provided greater validity to the findings.
(2) The implications to the trust to patients are discussed in the original study. All patients were from my own clinic (per request of the IRB) and all have remained my patients after the study. Debriefing them about the nature of the study did not end our patient-physician relationship. They understood that the scientific question being probed required the calibrated use of deception.
(3) The study does not advocate for the use of placebo. It advocates for the interpretation of these findings as indicating that there is an untapped opportunity to magnify the magnitude of benefits of standard interventions by enhancing their perception of efficacy.

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