"How do you convert a simple saline solution into a useful treatment for people with Parkinsons disease Tell them its a drug that costs  per dose. And if you want to make it even more effective tell them it costs  instead. Thats what researchers from the University of Cincinnati discovered in an unusual clinical trial. Instead of testing a placebo against an actual drug they pitted two placebos against each other. The only difference between the two sham treatments was their purported price. Medical researchers are well aware that the dummy pills used in clinical trials often provide as much relief as the actual drugs being tested. This is whats known as the placebo effect http and its quite common in people with Parkinsons a movement disorder http_diseaseparkinsons_disease.htm that causes tremors stiffness and balance problems. A  metaanalysis http found that placebos used in clinical trials of Parkinsons treatments improved symptoms by an average of . The team from the University of Cincinnati and their colleagues had a hunch that patients would be more responsive to a fake drug they thought was real if it came with a heftier price tag. The higher price would be seen as a signal that the treatment was better they figured. So they recruited  patients with moderately advanced Parkinsons and asked them to participate in a clinical trial of a medication described as a new injectable dopamine agonist. Patients with Parkinsons lose the brain cells that produce dopamine and a drug like this could pick up the slack. The study volunteers were told that there were two versions of the experimental drug and that both were believed to work equally well. The main difference the story went was the way they were made. As a result one version cost  times more than the other. In reality both placebos were composed of the exact same saline solution. And yet the patients perceived the expensive version to be more effective than the cheaper one according to results http published Wednesday in the journal Neurology. Both of the placebos improved motor function compared with a base line test. But when patients got the perdose placebo their improvement was  greater than when they got the perdose placebo the researchers reported. In another test  of the patients were judged very good or having marked improvement after they took the expensive placebo compared with  of patients after they took the purportedly cheap placebo. The researchers also used functional MRI scans to assess the patients brain activity and found that the cheap placebo prompted more action than the expensive one. To the researchers this was a sign that the patients expected less from the placebo they believed cost less so their brains responded by doing more work. Patients expectations have an important role in the efficacy of medical therapies the researchers wrote. Another manifestation of this is the preference many patients have for namebrand drugs instead of their generic counterparts they added. Placebos may be fake but understanding the placebo effect  and finding ways to make the most of it  is a real priority for researchers. To the extent that doctors can use placebos to improve patients symptoms they can use the real drugs less which may be expensive or toxic. Placebo can be the physicians friend a pair of neurologists wrote an editorial http that accompanied the study. The outcome of this study  opens our eyes to another nuance of placebo effect."