2015-06-07 10:45:02
Red pills work better than blue pills as stimulants
The main objective of science is to discover natural phenomena and explain how they work and why they occur. Needless to say, this is not always easy: some phenomena cling to mystery and are difficult to explain. One of these, still unexplained, is the placebo effect, along with its antithesis, the nocebo effect.
The placebo effect is the beneficial health consequence of administering some ineffective substance, or performing a medical procedure, which should not cause any benefit. On the contrary, the nocebo effect results in the reduction of the beneficial effects of drugs or procedures that have nevertheless been proven effective.
Both effects seem to depend on patients’ expectations about the treatment they receive. Specifically, hopes are important for the effectiveness of a treatment, since the same dose of active drug, secretly administered to the patient, has a smaller effect than when the drug is administered with the patient’s knowledge. In other words, expectations of cure contribute to the positive effects of a particular medication.
How the placebo effect works is not yet known in detail. If we discard mystical and spiritualist explanations, or those that invoke bodily energies that have not yet been detected, much less confirmed, the placebo effect must depend on neurological mechanisms, on a consequence of the simple knowledge that there is someone or something that is going to cure us of our illnesses, since, by definition, the placebo lacks an active ingredient and therefore cannot exert any physiological effect.
In fact, changes have been detected in the activity of some areas of the brain induced by the administration of placebo. Likewise, changes have been detected in the production of neuroactive substances, such as endocannabinoids and opiate peptides, which act on certain neuronal circuits. These substances can be produced to a greater or lesser degree depending on what we expect to happen to us, that is, when we anticipate a punishment or a reward.
Expectations, of course, also depend on the information we have. Thus, a placebo presented as a stimulant will stimulate and increase heart rate and blood pressure, but a placebo presented as a calmer will calm us down.
The factors that affect the perception of the effectiveness of the supposed medicine are also very important. For example, several studies have shown that red pills work better than blue pills as stimulants, but blue pills work better as pain relievers. Capsules appear to exert stronger placebo effects than pills, and the size of capsules and pills is also important, with large pills exerting greater placebo effects than small ones.
Value and price
Even more surprising is the fact that people’s motivation and life goals, as well as the education and culture where they live, can significantly affect the placebo effect in certain diseases, but not in others. For example, the placebo effect related to the treatment of stomach and duodenal ulcers is very low in Brazil, more intense in northern European countries, such as Denmark and the Netherlands, and maximum in Germany. However, placebo treatment for hypertension is lower in Germany than in other countries. These, without a doubt, are phenomena whose causes are not yet understood, which could even be genetic.
Another factor that has been implicated in the placebo effect is the price of the treatments. In general, a more expensive treatment is perceived as more effective by those who receive it. If this is true, a treatment perceived as cheap will exert a smaller placebo effect than a treatment perceived to be expensive.
To verify this, researchers from the University of Cincinnati, in the USA, carried out a study with 12 patients with Parkinson’s disease, susceptible to the placebo effect, to whom they administered two placebo treatments without them knowing that they did not contain any drug. One of them involves an injection of a saline solution that patients are informed costs $100. The other “treatment” consists of the same saline injection, but which patients are led to believe costs $1,500. After receiving the injections, the patients were examined to evaluate their motor abilities (Parkinson’s disease is characterized by problems in controlling movement) and the activity of their brains using functional magnetic resonance imaging.
A first surprising fact was that the resonance images indicated brain activation in the same areas that are activated after the administration of a real drug, such as levodopa. Even more surprising was the fact that this activation depended on the supposed price of the treatment received, with greater activation obtained in the case of the most expensive treatment. Furthermore, the injections also temporarily improved the patients’ motor abilities in a price-related manner.
For ethical reasons, patients were informed of the real purpose of the experiment once it was completed. The majority showed their astonishment at the strength of their expectations in the improvement of their condition and because these depended on the price that they had been led to believe the treatments cost, a price that, unconsciously and erroneously, they associated with the expected effectiveness.
This is the human mind. At least that’s how it is in a society that uses money as a measure of value. Antonio Machado already said it: “every fool confuses value and price.”
Reference:
Alberto J. Spain et al. Placebo effect of medication cost in Parkinson disease. A randomized double-blind study.
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