In the United States, many provisions of the Affordable Care
Act (also known as Obamacare) is the law of the land. Opponents of the law have been concerned that it
will ultimately reduce some people’s options for the care that they receive,
even as it increases the number of people who are insured overall.
The long-term implications of this law for health care are
not at all clear, but there is an interesting question about the role of
options in health care. Does it matter
if people have a choice among a set of treatment options?
This question was explored in a paper in the October, 2013
issue of the Journal of Personality and Social Psychology
by Andrew Geers, Jason Rose, Stephanie Fowler, Heather Rasinski, Jill Brown,
and Suzanne Helfer. They were interested
in whether the option to choose a treatment would influence people’s perception
of pain and discomfort.
In one study, participants came to a lab set up to look like
a medical testing facility. Prior to the
experiment, the participants had filled out a questionnaire measuring how much
they like to have control over situations in their lives. When they arrived at the experiment, they
were told that they would be placing a hand in very cold water. Then, they were shown two jars of
creams. One group was told that these
creams were two different kinds of protection against the cold. One cream was described as warming the hand
to protect like a glove, while the other was described as blocking pain
receptors. A second group was told that
the creams were different kinds of cleansers, one of which was organic and the
other of which was made in the United States.
Half of the people in each group were allowed to choose which cream they
wanted to have applied, while the other had a cream selected for them by the
experimenter. Then, they put their hand
in the water for over a minute and then rated their discomfort.
The people who had no choice over the cream they got
experienced slightly less pain when they were told the cream was a protector
than when they were told it was a cleanser.
This finding is a classic placebo effect. People who had a choice showed a different
pattern. When people had a choice and like to have control over their lives,
then they showed a large placebo effect.
Choosing a protecting cream led them to feel much less pain than
choosing a cleansing cream. People who
do not desire control over their lives showed no difference in their perceived
pain regardless of whether they were offered a choice between protecting creams
and cleansing creams.
So, the placebo effect was most powerful for those people
who desire control and were given a choice.
This finding was repeated in a second experiment involving a
choice of colors that some people were told are soothing, where the pain was a
loud noise. In addition, a third
experiment found that the desire for control could be manipulated by having
people imagine situations in which they did not have control and wanted it or
had control when they didn’t want it. The
same pattern was observed in both of these studies. When people had a high desire for control,
then choosing a treatment led to large placebo effects. When they had a low desire for control, then
choosing a treatment removed the placebo effect.
What does all of this mean?
Placebo effects are extremely powerful, particularly for
pain relief. So, it is valuable to know
when the largest placebo effects will be observed.
Choice of treatments can be good, but it depends on how much
people like to have control. Those
people who (either because of their personality or the situation) like to have
control over their lives should be able to choose their treatments. Those people who do not like to have control
over their lives should have their treatments chosen for them.
Finally, it is important to recognize that this study
involved only placebos. There were no
active ingredients in any of the treatments given in this study. It is not entirely clear what will happen
when the treatments also involve actual drugs.
