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Selasa, 03 Maret 2009

Expensive yet Effective Placebo

Inspired from Dan Ariely's Predictably Irrational
Chapter 10: The Power of Price: Why a 50-Cent Aspirin Can Do What a Penny Aspirin Can't

If you live outside Indonesia, you may not know a magic boy named Ponari. I, myself, do not really follow the media coverage on him, but I can tell you something. Many, many people have visited the kid to ask him for a magic healing. The boy has a stone, but not just a stone. He uses it to heal all kinds of his patients' illness. Although I am afraid that he works together with the devil himself to practice the treatments, I am not the one having the authority in this area. So I can't stop him. Most of us can't. In the bright side, the economic activities around Ponari's residence turn very attractive, though.

A friend of mine and I often debate on the issue of miracle events. On the one hand, I always propose that magical capabilities should be cautiously judged, since there is a chance the miracles come from not God but the devil. I argue that the miracles from God cannot be controlled. Even the one having such karomah doesn't know his magical capabilities. Everything magical can be accepted only if explained in Al-Qur'an and Al-Hadits. On the other hand, he - my friend - usually argues that the magical knowledge and capabilities can be learned. Not only can they be learned, but they are also legitimate to learn, referring to a verse in Al-Qur'an in the context of Prophet Sulaiman's story. Furthermore, he claims that he knows somebody having those kinds of divine gifts. In short, our perspectives diverge significantly.

Back to Ponari, I'd like to assume in this article that the kid's miracles just come from the air. Not from God! But he is also clean from relationships with the devil's apparatus. Let this tough, superstition issue be handled by the Ministry of Religion Affairs and Majelis Ulama. Having assumed that, I deliberately will focus on the possibility that magical treatments, like voodoos, are just placebo. You know placebo, right? It is bogus. Fake! Nonetheless, if someone really believes in it, it will be very effective for her/him. The instrument making placebo effective is so near, inside our mind.

Placebo is a usual technique used by doctors and pharmaceutical professions to clinically test the efficacy of medicines or treatments. It is even used to treat some patients. A popular treatment can be merely having a placebo effect. We just don't know it. We can't tell whether it is a real treatment or just placebo. In the mid twentieth century, there was a very popular surgical treatment entailing a chest incision, a cut on certain ligament, and more to treat some kind of chest pain. The surgical procedure was very popular for about twenty years until it was discovered that a placebo surgical treatment entailing only a chest incision had an exactly similar effect.

In a search to answers related to placebo effects, Dan Ariely and colleagues devised an interesting experiment. They created a painkiller, named Voladone and tried it in MIT Media Lab to many patients, about 100 adults. They used an electric shock machine to simulate a spectrum of pains. Here it was...

One patient coming to the lab was served by a sales consultant. Using her Russian accent, she explained the fantastic result of Voladone as an effective painkiller. After that, a series of pains were simulated to the patient using the electric shock electrode. Then he was given the painkiller whose list price was $2.50 per dose. Quite expensive. The capsule took about five minutes for the most optimum effect. Finally, similar pains were again simulated. Strangely, he felt the pains were much less painful compared to his first experience. Almost all patients coming to the clinic reported similar thing.

Dan Ariely changed the experiment a bit. The price list was changed from $2.50 to 10 cents. The experiment was then resumed following the same procedure as in the first one. The result? Only about fifty percent of the patients reported the efficacy of Voladone. Patients with more recent pain problems reported Voladone was nothing better than the usual painkillers they consumed. It seems that price has a placebo effect too. Expensive placebo can be more effective. Please note that Voladone is merely vitamin C.

Dan Ariely conducted another experiment. He studied two groups of MIT students. The first group consumed painkillers with the original list price, while the second consumed discounted painkillers. Again price indeed showed its dominance. Discounted products are often related as low quality. In the area of health and medicine, we often get what we pay for. It is not necessarily because of the actual potency of the drugs or treatments, but because of the price's placebo effect. How strange! How irrational.

The issue discussed here is so controversial that even Dan Ariely doesn't have all the answers. I, however, try to suggest in the case of Ponari that the Ministry of Health should put enough attention for the well being of the public. Are we all better off if Ponari with his placebo stone is prevented from doing his treatments? Or are we better off if the authority lets Ponari alone with his patients? If the ministry prevents him from practicing, probably at the same time it must enhance the overall quality of public health services.

Now, if we specifically talk about the "Indo Serbu" program, probably the Ministry of Health should make medicines "for the people" even more readily available. People should be able to obtain them from nearby stores, only five minutes away walking. How about the cost?

Well, since the price has a positive placebo effect, the government can indeed raise the list price significantly. This makes the medicines more potent. For the poorest, however, the government can give the medicines away, through a mechanism similar to "Bantuan Langsung Tunai" program, along with the higher list price. Hence, Serbu doesn't mean seribu (a thousand rupiahs) anymore but could mean sepuluh ribu (ten thousands rupiahs). Would it work? Probably! Hopefully then, we don't have to waste our energy responding to such phenomenon as Ponari's.

Finally, even though I assumed in this article that Ponari might only have had a placebo effect, I am still afraid that he works in an area of superstition. O God please help us out of a more serious problem: spiritual illness.

Next: Integrity Again
Prev: Bias Judgement

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