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Patients May Buy Idea of Injectable Meds With a Little Manipulation

(Reuters Health) - Patients who may be reluctant to start using an injectable medication warm to the idea when they are first offered a once-daily shot, then presented with the alternative of a once-monthly shot, a small study finds.

A psychological phenomenon called anchoring - the tendency to make judgments relative to the first piece of information presented - is familiar to marketers, the research team writes in a paper online June 14 in JAMA Dermatology.

A $500 item marked down to $100 seems like a better deal than an item simply priced at $100, for example. And doctors might be able to use this trick to help patients get over an aversion to medications called biologicals that require self-injection.

"Biologic medications are highly effective drugs. However, drugs don't work in patients who don't take them," said lead study author Elias Oussedik of Wake Forest University in Winston-Salem, North Carolina.

The researchers divided 100 adult psoriasis patients into two groups. Half answered a questionnaire that asked, among other questions, about their willingness to take a daily injectable medication and later asked if they would use a monthly injectable drug. Participants rated their willingness on a scale of 1 to 10, with 1 representing "not willing" and 10 "very willing."

The other half of patients answered a similar questionnaire that only asked them to rate their willingness to take a once-monthly injectable drug.

On average, people in the first group rated their willingness to take a monthly injectable drug at 7.5, while the second group averaged a rating of 2 on the same question.

"We were surprised to see how unwilling patients were to consider a once-a-month injectable medication for their psoriasis," he told Reuters Health by email. "After all, these drugs are some of the best treatment options for psoriasis and are, for the most part, hassle-free."

Patients who haven't taken an injection for psoriasis may compare the possibility of taking one to not taking one, rather than how frequently to take one, the study team writes. Resetting that anchor could help patients overcome a fear of shots, they note.

"Perceptions are malleable and these psychological tools widely used in commerce can be put to use in medical decision making, too," Oussedik said.

"We are hoping to repeat this study with a larger sample size to see if different cultures or groups of people respond differently to anchoring interventions," Oussedik added. "We're also looking at other behavioral economic principles and how they can be applied to the medical decision-making process."

At the same time, this behavioral economics approach, which offers a "bargain" for patients, poses some ethical concerns, the study authors acknowledge. Anchoring may be seen as manipulating patients' perceptions, and shouldn't be misused, they write.

"My first thought is that I do not think this is ethical," Dr. Arthur Kavanaugh of the University of California, San Diego, who wasn't involved in the study, said by email.

"If there were two medications - one that was really injected daily and one that was really injected monthly and they were similar in terms of safety and efficacy - and I offered them both to the patient but first offered the daily one (perhaps because it was cheaper) and then the monthly one, that would seem to be fine," said Kavanaugh.

But this study seems to suggest consciously tricking the patient to encourage them to take an injectable medicine, he added.

"To me, it would be similar to offering a fake drug with all sorts of horrible side effects and then offering an actual drug with actual side effects," Kavanaugh said. "The patient would likely not worry as much about the side effects of the actual drug, so it would work, but I'm not sure it's ethical."

SOURCE: http://bit.ly/2s0xz78

JAMA Dermatol 2017.