'Expensive' Placebo Better Than 'Cheap' One In Parkinson's Disease Study

An ‘expensive’ placebo proved to be more effective than a cheaper one in a Parkinson’s disease study, researchers reported on Wednesday.

The research found when patients with the disease received an injection described as an effective drug which cost $1,500 per dose, their motor function improved significantly as compared to receiving a supposed drug costing $100. The improvements occurred even when both injections contained only saline.

Previous studies have demonstrated that expectations from Parkinson’s patients can improve motor function. The degenerative disease results from the death of dopamine-generating cells in a region of the midbrain.

Neurologist Alberto Espay of the University of Cincinnati, who led the newest study, said dopamine release is increased by the belief of an award. The placebo effect proves to work when patients expect symptoms to improve, and that effect is enhanced when adding information about the cost.

Espay and his colleagues told 12 Parkinson’s patients that they would receive two formulations of equal effectiveness of the same drug. They were told the new drug would help their brains produce dopamine. The patients would receive the second shot after the first wore off in effectiveness.

They were told the difference between the injections was that there was a cost variation in manufacturing the drug. In actuality, the patients were unaware the formulations were placebos containing only saline and their motor functioning results would be based on perception.

When patients received the ‘expensive’ placebo their motor function improved two-fold over the cheap placebo and 28 percent over the baseline. The effect increased when they were given the expensive drug first.

However, their motor function didn’t improve as greatly as it did with the Parkinson’s drug levodopa, though the expensive placebo came close.

“I attribute this to patients’ perception of greater quality intervention when cost is higher than what they would have been accustomed to,” said Espay.

Eight of the patients expected the expensive drug to be more effective and that they experienced a much greater improvement as compared to the lower costing injection. Four patients said they didn’t expect better results from the $1,500 injection and that they “showed little overall changes” in motor function.

Though only 12 people were involved in the study, the findings supported and extended previous research that the placebo effect works in helping Parkinson’s disease patients.

Additionally, deceiving patients in Espay’s study raised serious ethical questions. Most studies in which researchers hide information from subjects are conducted with healthy volunteers. This study received extensive review because it involved actual patients.

Ted J. Kaptchuk, director of the Program in Program Studies and Therapeutic Encounter at Harvard Medical School, critiqued Espay’s work. “I don’t think it has a direct practical application. Telling people something is expensive, that’s deception. That’s not allowed in clinical practice.”

The study that an expensive placebo was more effective than a cheaper one was published online in the journal Neurology.

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