I’d like to begin by saying this is the finest column we have ever run. We spared no expense in its creation. It is so good, in fact, I have read it myself—twice. That’s not to boast, it’s just meant to enhance the experience of reading it for you.

 

Dan Ariely began thinking about placebos during the three years he spent in a hospital in Israel, where he was recovering from third-degree burns to 70 percent of his body following the accidental explosion of a military flair.

 

While recovering from his injuries, he would overhear doctors talking about specific patients who could not receive additional painkillers because they had reached their maximum dose, and then watch nurses provide them with subsequent injections. When he asked the nurses about it, they would confess they gave the patients a simple saline solution instead of the good stuff. He watched these patients calmly drift off to sleep after the injections of placebos.

 

“One of the things I’m interested in is how the inferences we make about things changes the reality we experience—how the role of expectation changes experience,” said Ariely, a visiting professor of behavior economics at Duke University and author of the recently published book Predictably Irrational (HarperCollins).

 

Ariely said placebo effects are well known. And, in the case of placebo pain killers, there is some explanation for why they work. The body starts producing natural opiods in anticipation of receiving them. Ariely, though, wanted to see what effect expectations have on the effectiveness of drugs. What he found was that a $2.50 placebo works better than a $0.10 placebo—even when they are the same placebo.

 

Though it’s a small study with a modest finding, it raises some very big questions about the possible unintended consequences of healthcare reform. It also raises big questions about the role not only doctors and pharmacists may be able to play in enhancing drug effectiveness, but also the role of the pharmaceutical companies, insurers, and policymakers.

 

Along with collaborators at the Massachusetts Institute of Technology, Ariely conducted a test on 82 subjects. The participants were given a light electric shock to their wrists and asked them to rate their pain. The researchers shocked the subjects before giving them a placebo.