We've all read about the enormous problem that placebos are causing the pharmaceutical industry lately. More and more, drug companies are unable to prove that their drugs perform better than a placebo (an inert substitute for the real drug, commonly a colored sugar pill) in clinical trials. In other words, patients who take the fake drugs or placebos get better or find relief from their symptoms pretty much at the same rate as patients who got the real drugs being tested.
No one is quite sure why the placebo effect is getting more powerful, only that it is. And they're also sure of one other thing as well – the color of a placebo influences how effective the patient believes it will be. For example, red placebo pills are consistently reacted to by patients as if they were stimulants, whereas blue or green placebo pills are consistently reacted to as if they were depressants or relaxants.
Well, now there is a study that shows that the color of real drugs affects whether the patient is willing to take the medication, or to continue taking it.
Brand-name medications vs. generic medications
To understand the basis of this research, you have to understand the distinction between brand-name drugs and their generic equivalents. In the pharmaceutical industry, the real profit is to be made in developing a new drug and then patenting it. During the period covered by the patent, which is a maximum of seven years, no other drug company can produce and release that drug and sell it for a lower price. This ensures that pharmaceutical companies have in most cases a seven-year "window of opportunity" during which they can charge whatever they like for the drug, maintaining an absolute monopoly on their discovery.
As an example of this, take the popular erectile dysfunction drug Viagra. It has been estimated that it costs its manufacturer Pfizer about 30 cents to create each pill. But in a pharmacy, brand-name Viagra sells for $10-13 per pill. That's a rather large profit margin, and a windfall for the Pfizer corporation, most of which will go away when the patent expires. At that point, other manufacturers can begin to create generic versions of Sildenafil citrate, the real name of the drug, and sell it at hugely reduced prices.
Ah, but will people buy the generic version of Viagra? Well, according to research performed at Brigham and Women's Hospital in Boston and published in the journal The Archives of Internal Medicine, they are not as likely to do so unless the generic version looks similar to brand-name Viagra, meaning that it looks like a diamond-shaped blue pill.
Color determined whether patients took a generic drug that didn't look like the brand-name drug
The study examined a large Blue Cross/Blue Shield database of prescriptions, covering many cases in which users who had previously been prescribed a brand-name drug were switched to its generic equivalent. They focused on a type of drug that had to be taken regularly, because it was used to treat epilepsy and their accompanying seizures, so skipping doses could be potentially harmful.
What the researchers found was that when the generic epilepsy/seizure drugs were a different color than the brand-name drugs that users had gotten used to taking, they were 27% more likely not to take them as prescribed. Many of the epilepsy patients simply stopped taking them, and failed to refill their prescriptions.
This is a big concern, because the failure to take prescribed medications, a form of behavior known as non-adherence, costs U.S. health providers 290 billion dollars per year in additional health complications. Dr. Aaron Kesselheim, assistant professor of medicine at Harvard Medical School and lead author of the study said, "Pill color is one of the things that policymakers should look at when they're trying to figure out ways of addressing this epidemic of non-adherence."
For the rest of us – those of us on the consumer or patient side of the issue – let this study be a cautionary tale. If you have been taking a brand-name medication and your doctor switches you over to its generic equivalent to save you and your insurance company money, keep taking it. It really doesn't matter if the new pill is a different color or shape – it's the same medication. Really. So taking a green pill instead of a blue pill or a round pill instead of a square pill isn't likely to affect your health, if it's the same drug. But not taking it? That definitely might.