"Nocebo effect" explains why patients may cite side-effects when switching medicines

MAY 3, 2017

In the last three decades, countless blockbuster prescription medications for a host of chronic ailments have become available as generics. Currently, about 56% of prescriptions in South Africa are now for generics (IMS, March 2017). This has shaved hundreds of billions of rands from the nation’s rising healthcare costs and has undoubtedly saved countless of lives by allowing more people to afford the medication they need.

Still, some people believe that more affordable medication can’t be as good as the brand name equivalents and fear that switching to a generic is risky.

Several studies found that generic substitution may be associated with a powerful phenomenon known as the nocebo effect where patients are so convinced that a medication disagrees with them that they start experiencing reduced efficacy and have imagined side effects. This possibly explains why switching from a brand-name medication to a generic version may cause people to report more side effects, even though both medications are chemically identical.

Mariska van Aswegen, spokesperson of leading SA generics firm, Pharma Dynamics says both the nocebo and placebo effects suggest the power of the mind, but should not be confused with one another.

“In placebo, our expectation of feeling better can lead to real physiological changes in our bodies, whilst patients who read about the negative side effects of a certain medication may be primed to notice these symptoms in their own bodies, described as the nocebo effect.”

A study conducted by the American Psychosomatic Society examined the effect that an apparent change in medication had on participants. Sixty-two university students participated in the mock study that tested the effectiveness of a supposedly “new” drug used to treat pre-exam anxiety. During the initial test, patients were told that they were being given the “brand name” drug, which was then supposedly switched to the “generic” version during the 2nd round of tests. Incredibly, researchers found that patients who thought they were being given the “generic” treatment reported more side effects along with a reduction in efficacy compared to when they took the “brand name” medication, even though all tablets were placebos.

 “Once a brand-name product comes off patent, a generic medicine manufacturer must ensure that the medication they are producing contains the same active ingredient(s) as the brand-name product, in the same dosage form, at the same dose or concentration and for the same route of administration.

“It also has to prove that it is as stable and pure as the original by meeting certain pharmacokinetic parameters in the body, for example, dissolving at the same rate and extent as that of the brand-name medication.”

Van Aswegen goes on to explain that patients who are anxious or stressed are more likely to suffer from the nocebo effect, especially when asked about the adverse effects of a medication. “They can even be triggered by the manner and behaviour of the doctor prescribing the treatment,” she says.

Generic medication is however just as safe and effective as their brand-name equivalents, and can save you up to 80% on your medication bill. To find out if there is a generic equivalent for the brand-name medication you are taking, ask your doctor or pharmacist for their recommendations.