Cultural Variations in the Placebo Effect: Ulcers, Anxiety, and Blood Pressure

Abstract

An analysis of the control groups in double-blind trials of medicines demonstrates broad variation--from 0 to 100 percent--in placebo effectiveness rates for the same treatment for the same condition. In two cases considered here, drug healing rates covary with placebo healing rates; placebo healing is the ultimate and inescapable "complementary medicine." Several factors can account for the dramatic variation in placebo healing rates, including cultural ones. But because variation differs by illness, large placebo effects for one condition do not necessarily anticipate large placebo effects for other conditions as well. Deeper understanding of the intimate relationship between cultural and biological processes will require close ethnographic scrutiny of the meaningfulness of medical treatment in different societies.

‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

“…This extends the idea of the 'placebo' beyond the idea of the accompanying therapeutic effect of giving a drug to a patient from a specific prescriber in a specific context (Claridge, 1970), to the therapeutic effect of entering a diagnostic process. The belief of health workers in this study that processes of care play a role in therapy mirrors findings of trials that various processes, including the use of instruments and labels for diagnoses, affect health outcomes (Moerman, 2000), reflecting the power of their symbolic value. It is interesting to ask why the health workers in this study use these concepts of 'placebo' and 'psychological' treatment.…”

Le médecin est-il un guérisseur? Une étude anthropologique auprès de cliniciens hospitaliers à Montréal

“…On peut se demander si le programme de formation en médecine prévient suffisamment les futurs médecins du pouvoir qui, selon les anthropologues en tout cas, accompagne la fonction à laquelle ils se préparent. Nos répondants auraient peut-être moins de raison de déplorer le manque d'humanisme d'une grande partie de leurs collègues si à la faculté de médecine on insistait davantage sur les études qui montrent à quel point l'attitude du médecin peut avoir une influence sur les symptômes du patient (Thomas, 1987;Hahn, 1995;Moerman, 2000). La taille restreinte de l'échantillon sur lequel a porté cette recherche et la méthode utilisée -celle des entretiens semi-dirigés -comportent des limites évidentes.…”

“…À l'intérieur du système biomédical, on a donné le nom d'effet placébo à la magie du guérisseur (Hahn et Kleinman, 1983a;Moerman, 2000). L'effet placébo, cette part de la guérison qui ne s'explique pas en termes biomédicaux, cette magie du guérisseur qui fonctionne vraiment, s'observe dans toutes les cultures (Brody, 1992;Moerman, 2000 (Fassin, 1996;Amarasingham Rhodes, 1996). Selon Brody (1992), le pouvoir du médecin n'est pas seulement médical -lié à ses connaissances -et charismatique -lié à son charisme personnel.…”

Reframing placebo in research and practice

“…Dan Moerman [4] reviewed 117 placebo-controlled trials of ulcers across multiple countries and showed that the response rate for ulcer healing in the placebo groups varied from 0 per cent to 100 per cent. There was wide variation from country to country, such as the response rate in Germany being high and the response rate in The Netherlands and Denmark being low [4]. Thus, what was proven in The Netherlands to have specific effects could never be proven in Germany.…”