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 直感がすべて。プラセーボ薬剤が苦痛軽減するのに、高い価格だとより高い価値があるという印象をあたえる。10セントのものより2.5ドルのプラセーボ薬に効果が高いとわかった。ジェネリックよりブランド品に効果があるという患者の報告を裏付けるものである。 鎮痛剤のプラセーボ効果が、安い薬剤では61%であるが高価な薬剤では85%と有意に高い鎮痛作用を示した。 以前の研究で人々は白いものは弱く、黒や赤のカプセルは効果が強いと思っているとわかった。また、製造国も影響する。 鎮痛効果を期待する時に、人は自分自身で脳内麻薬opioids を分泌する。ディスカウントで購入すると効果を疑ってしまい体が反応しない。 -------------------------------------------- More Expensive Placebos Bring More Relief http://www.nytimes.com/2008/03/05/health/research/05placebo.html?_r=1&oref=slogin By BENEDICT CAREY Published: March 5, 2008 In marketing as in medicine, perception can be everything. A higher price can create the impression of higher value, just as a placebo pill can reduce pain. Now researchers have combined the two effects. A $2.50 placebo, they have found, works better one that costs 10 cents. The finding may explain the popularity of some high-cost drugs over cheaper alternatives, the authors conclude. It may also help account for patients’ reports that generic drugs are less effective than brand-name ones, though their active ingredients are identical. The research is being published on Wednesday in The Journal of the American Medical Association. The investigators had 82 men and women rate the pain caused by electric shocks applied to their wrist, before and after taking a pill. Half the participants had read that the pill, described as a newly approved prescription pain reliever, was regularly priced at $2.50 per dose. The other half read that it had been discounted to 10 cents. In fact, both were dummy pills. The pills had a strong placebo effect in both groups. But 85 percent of those using the expensive pills reported significant pain relief, compared with 61 percent on the cheaper pills. The investigators corrected for each person’s individual level of pain tolerance. “It’s a great finding,” said Guy H. Montgomery, an associate professor of cancer prevention at the Mount Sinai School of Medicine who was not involved in the research. “Their manipulation of price affected expectancies of drug benefit, and pain is the ultimate mind-body phenomenon.” Previous studies have shown that pill size and color also affect people’s perceptions of effectiveness. In one, people rated black and red capsules as “strongest” and white ones as “weakest.” Other information like the country where the drugs were manufactured can also affect perceptions. “It’s all about expectations,” said the lead researcher, Dan Ariely, a behavioral economist at Duke and the author of a new book, “Predictably Irrational: The Hidden Forces That Shape Our Decisions” (HarperCollins). His co-authors on the report were Rebecca Waber, Baba Shiv and Ziv Carmon. “When you’re expecting pain relief, you’re secreting your own opioids,” Dr. Ariely added. “And when you get it on discount, you doubt it, and your body doesn’t react as well.” Eric Nagourney contributed reporting. ------------------------------------------ 'Expensive' Placebos Work Better Than 'Cheap' Ones Odd Experiment Suggests a High Price Tag May Be a Formula for Pain Relief http://abcnews.go.com/Health/MindMoodNews/story?id=4386984&page=1 By LAUREN COX ABC News Medical Unit March 4, 2008 The more expensive your pain medications are, the better the relief you get from taking them ― even if they're fake. That's according to a study published this week in the Journal of the American Medical Association, which suggests that sugar pills labeled as expensive drugs relieve pain better than sugar pills labeled as discounted drugs. Researchers often compare real drugs to sugar pills in medical studies to account for the placebo effect, in which the illusion of taking medicine alone can cause symptoms to disappear. But Dan Ariely, a behavioral economist at Duke University in Durham, N.C., and a team of collaborators from the Massachusetts Institute of Technology compared the placebo effect of the marketing that people are asked to swallow along with their medicine. In the study, 82 volunteers were subjected to a series of electric shocks ― a standard research protocol for measuring pain thresholds. They were then given a placebo pill alongside a fake drug company brochure for the fictitious drug "Veladone-Rx," ― ostensibly a new fast-acting painkiller made in China. The only catch was that half of the test subjects received brochures showing that the drug had been marked down from the original price of $2.50 a pill to 10 cents a pill. These modified brochures also included circled fine print which suggested that the pills were manufactured in China. After participants went through the shocks again, 85 percent in the full-price group reported pain relief from their sugar pill, while only 61 percent in the discount group reported pain relief. Placebos Make Good Medicine "In a way, placebo is a big part of medicine," said Ariely, who wrote an entire book on the subject called "Predictably Irrational." The placebo effect goes beyond simple perception. In fact, people taking placebos for pain relief will secrete higher levels of the body's natural painkillers called endogenous opioids, said Ariely. "But the interesting thing is, we can't close our eyes and say, 'please can I get some pain relief?'" said Ariely. "It's under our control, but not under our control consciously." The placebo effect is so powerful, it can help 25-50 percent of patients with migraines, said Dr. Timothy A. Collins, associate clinical professor of neurology at Duke University Medical Center. "It can even help with unexpected medical conditions such as with the skin disorder psoriasis, which has a 27 percent favorable placebo rate for patients, or a 16 percent placebo rate with Parkinson's disease." But while many doctors are quite aware of the placebo effect, some may not be aware of all the elements that go into it ― including the price of the pill, the drug ads on TV, or even the physician's attitude towards the drug, said Ariely. Get What You Pay For, or Buyer Beware? A common reason to go after a brand-name drug is the popular saying "you get what you pay for." "It's true with cars, it's true with other consumables," said Dr. Nortin Hadler, professor of medicine at the University of North Carolina at Chapel Hill. "If you buy a lemon and drive it home, you're going to know in a hurry. "But when it comes to health care issues, you don't know it in a hurry ― you don't know," Hadler said. Dr. Carmen Green, director of Pain Medicine Research at the University of Michigan Health System, has frequently experienced this phenomenon in her practice. "Patients come in and say, I saw this on TV and this is what I want," said Greene. "But often there are other drugs that are available that are cheaper, or should be tried first." Besides occasionally annoying doctors, the drive towards more expensive drugs might have costs that go beyond the pockets of people watching drug ads. "We're all paying for higher health care costs, whether you have government insurance or private insurance," said Greene. Yet, not all is doom and gloom. Ariely and Hadler believe doctors can turn the placebo effect around for the advantage of both the doctor and the patient. Office Visit: Expanding Placebo "It really puts a new twist on how we think about reality," said Ariely, who questioned how price and marketing affects the potency of drugs given out in free packets, drugs given in discount rates, or even drugs that come in boring bottles. For Hadler, the study might convince doctors to develop their own positive marketing for a treatment. In his own studies, Hadler has found that the way a physician describes a drug can change how much a patient will follow through with a treatment regimen. "Compliance goes down when you go through all the side effects listed for the drug," said Hadler. "But if you say, 'This is the best thing ever, side effects are rare,' people will respond positively." ------------------------------------------ Commercial Features of Placebo and Therapeutic Efficacy http://jama.ama-assn.org/cgi/content/extract/299/9/1016 To the Editor: It is possible that the therapeutic efficacy of medications is affected by commercial features such as lower prices. Because such features influence patients' expectations,1 they may play an unrecognized therapeutic role by influencing the efficacy of medical therapies, especially in conditions associated with strong placebo responses.2-3 To investigate this possibility, we studied the effect of price on analgesic response to placebo pills. Methods In 2006 we recruited 82 healthy paid volunteers in Boston, Massachusetts, using an online advertisement. Each participant was informed by brochure about a (purported) new opioid analgesic approved by the Food and Drug Administration; it was described as similar to codeine with faster onset time, but it was actually a placebo pill. After randomization, half of the participants were informed that the drug had a regular price of $2.50 per pill and half that the price had been discounted to $0.10 per pill (no reason . . . [Full Text of this Article] Rebecca L. Waber, BS Massachusetts Institute of Technology Cambridge, Massachusetts Baba Shiv, PhD Stanford University Stanford, California Ziv Carmon, PhD INSEAD Singapore Dan Ariely, PhD ariely@mit.edu Massachusetts Institute of Technology |
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英語んとこは分からないけれど、日本語の要旨には「大笑い」。 |
廣瀬_敏之 2008/03/06 04:27 |
最後の英文引用が該当するウエブページhttp://jama.ama-assn.org/cgi/content/extract/299/9/1016。 |
医師の一分 2008/03/08 22:28 |
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