The medication you select from the store shelf could influence its adverse effects, depending on your opinion of the drug. Scientists from the University of Colorado at Boulder, the University of Cambridge, and from Hamburg, Germany found that pricier meds can actually cause adverse reactions.
The study investigated how medication pricing affects the nocebo effect, an effect opposite of the placebo effect where a trial’s medication causes adverse reactions. Lead researcher Alexandra Tinnerman said the nocebo effect has seen little attention in the past.
“There has been a lot of research on placebo and relatively little on nocebo,” Tinnerman told Science Mag. “These findings add up to the fact that expectations have a lot of influence on the perceptions of a drug’s side effects.”
The study analyzed brain imaging to further understand how medication pricing can influence the nocebo effect. By referring to the images, the researchers were able to characterize brain circuits involved in the nocebo effect, identifying pain pathways from the prefrontal cortex to the spinal cord.
To understand the effects of medication value, the researchers gave participants two different kinds of an anti-itch cream. One cream was packaged as an on-brand anti-itch cream with the label ‘Solestan Creme’ in high-end packaging meant to have participants perceive it as the more expensive brand.
The second cream was packaged in cheaper, off-brand packaging resembling that of other generic off-brand drugs, labeled ‘Imotadil-LeniPharma Creme.’ Tinnerman said the work that went into the packaging was careful to consider the participants.
“I put a lot of effort into making the designs look convincing,” she said.
Researchers informed the patients that the creams could cause increased sensitivity to pain after applying the medication to participants’ forearms. They then attached a device to the participants’ arms that gave a flash of heat of about 113 degrees.
Participants who received the more expensive-looking cream reported an increase in pain over time, while those who received the generic cream reported a decrease in pain sensitivity. The brain imaging supported the participants’ reports, with those who said they felt more pain experiencing more activity in the prefrontal cortex.
Tinnerman said previous studies have shown a spike in activity in the prefrontal cortex when participants experience the placebo effect as well as when they enjoy a product based on their perception of its value. The study said value information about a drug, like that of a price tag, can strongly influence its therapeutic effects on patients, even when the drug is missing its active ingredient.
Per Aslaksen, a psychologist with the University of Tromsø in Norway involved in researching the placebo effect who was not involved with the study, said physicians should be aware of both kinds of effects.
“Both doctors and patients can often choose between several medications, and the price of the drug is sometimes the only factor that separates different types of drugs,” he said.