With a price tag like that, you know it’s what’s best

Would you pay more for name-brand headache medicine than the generic or store brand?  If your budget is like mine, probably not; after all, the tablets are the same, it’s just the packaging that’s different.

But on the flip side, what if your favorite practitioner recommends an expensive treatment that will help you or your loved one recover from a chronic condition? Not surprisingly, treatments with higher price tags make patients feel better, even when there are not any differences in the treatments, nor even when the treatments are just placebos!  Per research by Waber et al., (“Commercial Features of Placebo and Therapeutic Efficacy”)

These results are consistent with described phenomena of commercial variables affecting quality expectations and expectations influencing therapeutic efficacy. Placebo responses to commercial features have many potential clinical implications. For example, they may help explain the popularity of high-cost medical therapies (eg, cyclooxygenase 2 inhibitors) over inexpensive, widely available alternatives (eg, over-the-counter nonsteroidal anti-inflammatory drugs) and why patients switching from branded medications may report that their generic equivalents are less effective.

In other words, patients perceive more expensive treatment as being more effective.  This is in many parts “research as confirmation of what we already know”, also known as “A Duh! Study”.  (Which is why it was in the 2008 Ig Nobel Awards.)  However, this preference for expensive treatments can also be a post-purchase rationalization, where we have the unconscious tendency to rationalize why the things we have paid for were such good choices.

Human beings are subject to a large number of cognitive fallacies and biases of judgment.  We unconsciously deceive ourselves in a number of ways, which is why scientists must use randomized, double-blinded, and repeatable studies with falsifiable hypotheses. (The word “falsifiable” is somewhat confusing or misleading; it simply means that the hypotheses can be proven wrong, which is statistically safer than trying to prove them correct.)

Our brains love to find patterns — that’s how we make sense of all the sensory input we’re bombarded with — but we will also see patterns even when they don’t exist.  Even the most earnestly objective researcher can misinterpret incomplete data, or give more attention to data that supports their hypothesis than that which doesn’t.  This is why double-blinded studies are important, so neither the study subjects nor the data gatherers know who is in the treatment or the control groups.

Naturally, shysters will take advantage of people by manipulating these various misperceptions.  That hefty price tag is part of the explanation for why woomeisters are able to peddle hellaciously expensive but dubious “cures” and “treatments” for various conditions, disorders and actual illnesses. It doesn’t even matter if a condition (such as autism) is primarily genetic and thus incurable.  (Note that some things like ADHD may sometimes be treated to reduce some of the effects or to lessen stresses; treatments are different than “cures”.)

Those “maverick” medics (and pseudo-medics) are also selling themselves, with their fables of how they nobly struggle against the status quo, Big Pharma, and everyone else who disagrees with their unproven claims or points out the lack of solid evidence for what they’re selling. Such self-described authorities encourage their clients to give their recommendations authority bias that goes beyond what is given to ordinary doctors.

Confirmation bias also plays into these scenarios, where clients will notice and remember any signs that the treatment might be working.  Indeed, subject-expectancy effects can create positive outcomes that would not have otherwise happened.  Patients will also assign any improvements to the treatment, even when those outcomes are no better than they would be without the treatment. Clients may also over-report improvements because they feel the need to be a “good patient”, thus earning positive reinforcement.

In addition to these natural biases that allow patients or clients to fall prey to sciency-sounding shysters, there is a whole other set of reasons why patients may reinforce each other to continue believing in the false promises of bunk cures, even when their own personal lack of results shows otherwise.  But that’s a post for another day.

3 Comments

  1. 15 January 2009 at 12:19

    […] want your head to asplode, you may not want to read the comments on that post).  Andrea discusses cognitive biases that make consumers vulnerable to […]

  2. 10 January 2009 at 14:33

    Sorry to be off topic, but I was wondering if you might be interested in blogging about this:

    Jerry Lewis, the man who runs the annual Telethon to raise money for people with muscular dystrophy in the US is about to receive a humanitarian award. Many people in the disability community is protesting this award because they feel that Jerry perpetuates and entrenches negative, harmful stereotypes toward people with disabilities. More about the petition campaign at: http://www.petitiononline.com/jlno2009/petition.html

    There is also a Facebook group at http://www.facebook.com/group.php?gid=40538392681

    (Side note, I like that you now have a button to allow people to ask for followup comments via email … wish I had that in my blog, but it doesn’t seem to be a feature of the particular design theme I use right now.)

  3. 3 January 2009 at 16:00

    Phew that’s a lot to deal with, if you are fit and healthy, let alone sick and anxious.
    The situation is different here in the UK, what is prescribes by your Dr is to some extent governed by NICE, National Institute for Health and Clinical Excellence
    http://www.nice.org.uk/aboutnice/nhsevidence/AboutNHSEvidence.jsp


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