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The nocebo effect is defined as a negative treatment effect that is induced by a patient's expectations that are unrelated to the pharmacologic actions of a medicine.⁴⁴ In any switching study, the subsequent biologic prescribed (like a biosimilar) is perceived to exert a lower therapeutic benefit due to this nocebo effect. The attitudes of doctors, patients, and payers are therefore crucial for the full acceptance of biosimilars because of the nocebo effect.⁴⁵