Why do more expensive drugs work better than cheaper ones?A couple years ago, my patient, Mary, came to see me complaining that her antidepressant medication wasn't working since she started getting the newly arrived generic version ($15/month vs. $180/month previously). There is overwhelming data that generic drugs are just as effective as their more expensive branded sisters. What was going on with Mary and her antidepressant?Dan Ariely, a behavioral economist recruited 82 volunteers to read about a new potent, rapidly acting pain medicine, recently approved by the FDA. Actually the pill was a placebo (sugar pill). Half the volunteers were told the new drug cost $2.50 per pill and the other half were told it cost 10 cents. Each group received the identical sugar pill.The volunteers were each given a series of shocks to their wrists, once before being given the "pain pill" and again after the pill. They were asked to evaluate the severity of each of the shocks. Then Dr. Ariely calculated the differences in the before and after responses ...i.e. how well did the pain medicine work?The results:Expensive Placebo Cheap Placebo 35/41 (85%) 25/41 (61%) ( % with a reduction in pain )So both the cheap and expensive sugar pills worked, but the $2.50 pill clearly relieved pain better than its cheap counterpart. The little study is strong support for the "placebo effect," but may also explain the failure of Mary's generic antidepressant. We are indoctrinated to: "You get what you pay for," and "there is no free lunch." Generic drugs, and The Free Press, are two notable exceptions.Dr. Mohler has practiced family medicine in Grand Junction for 38 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans.