A Spoonful of Sugar

Illustration by Mimi Shang

Illustration by Mimi Shang

In clinical trials that uphold the gold standard of double blind placebo controls, an inert pill is compared to the tested drug to measure the efficacy of the tested drug. If the efficacy of a tested drug is not determined to work better than the placebo, then the drug is not considered effective. Because a placebo can produce what is known as the “placebo effect,” the tested drug is compared to a placebo as the placebo. The placebo effect occurs when the patient or experimenter’s expectations of a drug can improve the patient’s condition. For this reason, the randomized groups are often distributed medication so that neither the experimenter nor the participant knows which drug they received. Sensory perceptions such as visual, tactile and olfactory stimuli can play an important role in the perception of the medicines consumed. Individuals associate sensations with certain feelings. These feelings can, in turn, manifest into physical changes.


Pharmaceutical companies have taken note of this effect and have thoughtfully chosen the color, shape, size and even taste of the medication. Even though the active ingredients in drugs are formulated to alleviate and counteract unwanted symptoms, other properties of the drug may aid in the healing process. For example, many people associate cherry flavored foods with choking down the last drops of cough syrup. In the same way, patients associate secondary properties of the drug with feeling better. Thus, secondary properties of the drug can be utilized as a placebo-based method to help treat patients.


Studies have shown that the process of ingesting medication starts even before it enters the mouth. People visually take note of the color and shape of the medication. For instance, it has been reported that pink tablets are sweeter than red tablets despite the tablets having the same ingredients (1). This perception is linked to a placebo connection, and it is estimated that double blind studies report a 55-60 percent of effectiveness rating of many placebos. Since placebos can have such potent effects, the properties, like color or taste, associated with medications may certainly lead to stronger beliefs in drug effectiveness and thus increase overall efficacy.


However, strong association with secondary properties may prove harmful. Some patients may use secondary properties as key points of recognition for drugs. This pattern of can have large repercussions. In the SK&F v. Premo case, two diuretic products had the same chemical composition but were absorbed into the bloodstream at different rates (2). This problem could potentially occur with any two products where the bioavailability of the product differs despite having chemically equivalent structures. Like finding out your coffee is from Cherry Tree rather than Starbucks, the implications of having identical looking drugs with different effects can lead to confusion for the consumer and, in the case of medical treatments, possibly dire health consequences.


However, two physically identical products that act differently on the patient’s body is not as contested as the monopolization of full priced, brand name drugs by large pharmaceutical companies. Currently, trade dress, a form of patenting the visual appearance of medications, is allowed if pharmaceutical companies can prove that the design of the product has acquired a secondary meaning among the public. The secondary factors that can contribute meaning and association can include color, size, shape, smell and flavor.
Pharmaceutical companies spend a lot of money on advertising and marketing of their products in order to associate the physical properties of the drug with the brand named product; however, high expenses for consumers should warrant a reconsideration of trade dress. Though generic drugs are produced using the same formula, patients are less likely to use the drug as prescribed (3). A study performed at Brigham and Women’s Hospital found that patients taking generic antiepileptic drugs were 50 percent more likely to demonstrate decreased adherence. This behavior can lead to increased mortality and raise health care costs to up to $100 billion. Differing visual cues, such as change in color and size, between generic medications is to blame for the confusion or prescription error by patients. Seeing as generic medications account for 70 percent of the prescriptions dispensed (3), implications can be extremely serious both medically and economically, so it is paramount that psychological factors should be taken into consideration when distributing medicine.

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