If I asked you to list the biggest hindrances drug companies face in bringing new pain killers to market, you would like have several suggestions. The expense, for example, of developing new medicines. Perhaps increased governmental regulation of the pharmacy industry? These are two excellent answers. But how about this one: the placebo affect? In a truly fascinating study, it turns out that drug companies are having an ever-harder time proving their products are better than a placebo--because the placebos work so damn well. Wouldn't you just know that this phenomenon is seen only in American drug trials. Elsewhere in the world, patients are better at telling the difference between an ethical drug and a placebo. So what is going on in the USA such that we cannot tell a placebo apart from a drug with a supposedly active ingredient? Researchers have a few ideas. One is that the relentless advertising by drug companies, in which they promise a cure for everything, is at work. The idea is that Americans are primed to think any pill a doctor gives them is going to work miracles. Including fake pills. There might be something to that. After all, some notable percentage of the maladies we suffer in this country are about as real as placebo medicines. Why not treat imaginary diseases with fake drugs? Sounds like the classic win-win. The next big challenge for the pharmacy industry is to get Americans to buy sugar pills for $500 a piece. After all, they work as well as the ethical drugs that cost that much. Fair is fair, right?