PSYCHOSOCIAL MODIFIERS OF DRUG PRESCRIPTION - THE HIDDEN FACE OF PHARMACOLOGY

Apart from placebo, there is scant medical knowledge regarding the inf luence of psychosocial effect modifiers in pharmacology. Phenomena suc h as the nocebo, Hawthorne, Oedipus and complacency effects have been previously described as sources of bias in clinical trials; however, t he effects related to prescription patterns have been widely ignored t o date. Under certain circumstances, psychosocial effects may even be catalysts for changes in the official regulations on drug prescription - changes often lacking an adequate scientific basis - and, subsequen tly, induce major changes in drug use worldwide. In spite of this, the study of psychosocial effects in pharmacology has been confined to an ecdotal reports. The present overview of this topic is aimed at encour aging the identification of psychosocial effects in pharmacology. It a lso suggests that commercial case studies of drugs are a suitable meth od for studying prescription and effect modifiers. Triazolam's commerc ial history provides a good example of this approach. A better knowled ge of these effects may contribute to a better understanding of the pr escription habits observed in clinical practice. It may also prevent p aradoxical changes in prescription patterns or in drug regulations. (C ) 1998 John Wiley & Sons, Ltd.