Expensive Placebos work better than cheap placebos

[Dr. Dukes]

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This doesn't have a lot to do with Emergency Medicine except that its pretty cool. The New York Times has an article on a JAMA study coming out today that showed people thought a placebo they were told was expensive worked better than a placebo they were told was cheap. I'd like to see them repeat this experiment with an actual drug with three group: a group told its Advil, a group told it is a brand new fancy painkiller, and a group told it is a generic cheap painkiller. Be interesting to see how those results turn out.

 

[hyperbaric]

Makes sense. If I were a patient, I would expect the best placebo available.

Is this supposed to have some application to clinical practice (aside from patient education)?

 

[Dr. Dukes]

Makes sense. If I were a patient, I would expect the best placebo available.

Is this supposed to have some application to clinical practice (aside from patient education)?

Well, it explains why patients often don't like taking generic drugs and will pay more for a brand name drug that is the exact same active ingredient as the cheaper generic.

 

[hyperbaric]

I'm with ya.

 

[NKMU]

That's why I only prescribe brand-name Obecalp to my patients.

 

[EctopicFetus]

Makes sense. If I were a patient, I would expect the best placebo available.

Is this supposed to have some application to clinical practice (aside from patient education)?

best doesnt equal most expensive.. Aspirin comes to mind.

 

[ccfccp]

best doesnt equal most expensive.. Aspirin comes to mind.

So... what you're saying is we have room to mark-up the price of aspirin?

 

[Dr. Dukes]

So... what you're saying is we have room to mark-up the price of aspirin?

The Times article also says that there was some study done showing that people thought the color and shape of the pill made a difference also. Apparently red means its good and white means wimpy. Bayer needs to make aspirin red and triple the price...

 

[USCDiver]

Times article also says that there was some study done showing that people thought the color and shape of the pill made a difference also. Apparently red means its good and white means wimpy. Bayer needs to make aspirin red and triple the price...

The ECASA are orange. Does that mean they're hot?

 

[ccfccp]

The ECASA are orange. Does that mean they're hot?

I think orange is supposed to make you hungry... you know... so you take more and it works better.

 

[Annette]

There was a wine test that showed people liked the wine better if they thought it was more expensive. Hmm, conceirge medicine with high rates = better medicine!

 

[Dr. Dukes]

There was a wine test that showed people liked the wine better if they thought it was more expensive. Hmm, conceirge medicine with high rates = better medicine!

Yeah dude!

 

[Febrifuge]

And tuition should be jacked up, so the next generation of students will not only believe they're learning a greater amount of info, they'll feel like they're intellectually superior to those who trained 10 or even just 5 years ago!

...oh, wait.

(Sorry... I've been looking at pre-med threads, and every time I do that I despair for the future.)

 

[Jeff698]

I was actually going to post about this before my shift today, thanks for doing it for me.

The thing about this that caught my eye was that price is inversely proportional to perceived value.

This is not news to me since I grew up as the son of a Chevy dealer. 🙂

It occurred to me that this is one of the reasons people seem to de-value the care they receive from emergency physicians. Since they don't have to pay (thank you EMTALA), they don't perceive us as a having much value.

Hell, if we're free, we must not be of much value.

Grrrr....

Take care,
Jeff

 

[Dr. Dukes]

It occurred to me that this is one of the reasons people seem to de-value the care they receive from emergency physicians. Since they don't have to pay (thank you EMTALA), they don't perceive us as a having much value

So maybe charging people before we read do anything about their 10/10 chest pain might not be a bad thing.

 

[VA Hopeful Dr]

So maybe charging people before we read do anything about their 10/10 chest pain might not be a bad thing.

Hardly, but I don't think its too unreasonable to charge the patient once its figured out that they aren't going to die/suffer irreversible harm in the next 60 minutes or so. Hell, if I were there I'd have no problem throwing my insurance card at someone back there so long as I'm not actively dying.

 

[EM2BE]

So maybe charging people before we read do anything about their 10/10 chest pain might not be a bad thing.

I heard there was a hospital back home that made all pay a $30 co-pay in the ED, whether they had insurance or not. I'm thinking it's a for-profit hospital, but by doing that co-pay, most opt to go to the "free" ED.

 

[docB]

Hardly, but I don't think its too unreasonable to charge the patient once its figured out that they aren't going to die/suffer irreversible harm in the next 60 minutes or so. Hell, if I were there I'd have no problem throwing my insurance card at someone back there so long as I'm not actively dying.

Interestingly every ED in the hospital system I work for is doing just that. We eval the patient and if they don't have an emergent condition they have to pay or seek treatment elsewhere. Of note ACEP has been debating this new phenomena of "deferral of care" at the council meetings and I think that they will officially come down against it this Oct.

Here's a thread about it from way back:
http://forums.studentdoctor.net/showthread.php?t=167548
As you can see I was dead set against this back then but now I've learned to live with it. If the Joint Comission has done anything for us it's taught us how to learn to put up with stupid and counterproductive initiatives.

Back to the OP's point about placebos I' think this is analgous to the fact that most patients think pain meds that come in shot form are better.

 

[EM2BE]

Back to the OP's point about placebos I' think this is analgous to the fact that most patients think pain meds that come in shot form are better.

My bf actually had to explain that there was no difference to someone the other day. His background in pharm (got a masters in it) helped him explain exactly why she was even better off taking the pills (because the dr prescribed it in a higher dose than the IV was giving her) and even went through the pharmacokinetics to tell her how she was even getting more from the pill because of the calculations and all the fun stuff I try to forget.