Psychosocial modifiers of drug prescription: The hidden face of pharmacology?

Apart from placebo, there is scant medical knowledge regarding the influence of psychosocial effect modifiers in pharmacology. Phenomena such as the nocebo, Hawthorne, Oedipus and complacency effects have been previously described as sources of bias in clinical trials; however, the effects related to prescription patterns have been widely ignored to 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, subsequently, induce major changes in drug use worldwide. In spite of this, the study of psychosocial effects in pharmacology has been confined to anecdotal reports. The present overview of this topic is aimed at encouraging the identification of psychosocial effects in pharmacology. It also suggests that commercial case studies of drugs are a suitable method for studying prescription and effect modifiers. Triazolam's commercial history provides a good example of this approach. A better knowledge of these effects may contribute to a better understanding of the prescription habits observed in clinical practice. It may also prevent paradoxical changes in prescription patterns or in drug regulations.