Drugs seem to cause worse side effects if people think they are cheap. This finding could encourage doctors to explain to people that treatments can be effective and safe regardless of whether they are trademarked brands or less expensive copies.
鈥淢ost people have heard of the placebo effect,鈥� says at the University of New South Wales in Sydney, Australia. 鈥淚t鈥檚 this idea that you can take a sugar pill, think it will work, and it鈥檚 going to cause health improvement.鈥�
The phenomenon examined in this study, however, is the nocebo effect, which is when a negative attitude can mean a drug ends up causing you harm, she says. 鈥淭he way I think of the nocebo effect is as the dark side of the placebo effect.鈥�
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When pharmaceutical firms have a new drug, they patent the discovery, give the treatment a catchy name and, if it gets approval for use, put it on the market. Once that patent expires, other companies can make generic versions, which are pharmacologically identical, but sold more cheaply.
鈥淲e see, at least under some circumstances, that when a medication is described or labelled or priced as a generic, it seems to both sometimes work less well and also cause more side effects,鈥� says Faasse.
To pick apart what is behind this, she and her colleagues recruited 196 people who were told they were receiving an oxytocin nasal spray, aiming to examine its effect on feelings of cooperation and trust.
Sixty-eight of the participants got information that made the treatment look like a branded drug, while for 66 others it was implied that the drug was generic. For about half of each group, this information related to its price (either AUS$2 or $30, which is about US$1 or $19). For the other half, it related to its name: short and catchy for the branded one (Halpam) and long and scientific-sounding for the generic (Halyazeoiipam).
All these participants were actually only given a saline spray, which they were told may cause side effects, such as headache, nausea or rashes. A further group of 62 people received nothing.
At the end of the study, those taking part rated their expectations of the drug and how bad any side effects had been using a standard scale. Those on the branded or more expensive sham drugs reported slightly more symptoms than the control group, but those on the generic-sounding or cheaper ones reported twice as many as the control group and had the lowest expectations.
This could help doctors or pharmacists word things in a way that elicits a healing response to a treatment, says Faasse. 鈥淲e are kind of indoctrinated to like expensive things: we think they鈥檙e better, they鈥檙e higher quality, they鈥檙e going to work better.鈥�
鈥淎 physician that explains why they鈥檙e prescribing or switching a patient to a generic medication 鈥� and does so empathetically and while mentioning the nocebo effect 鈥� can prevent the patient from feeling like they鈥檙e receiving inferior treatment, and thus increase the treatment鈥檚 effect,鈥� says at Leiden University in the Netherlands.
PsyArXiv
