Deconstructing the Placebo Effect and Finding the Meaning Response

Moerman, Daniel E.; Jonas, Wayne B.

doi:10.7326/0003-4819-136-6-200203190-00011

Cited by 642 publications

(448 citation statements)

References 45 publications

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“…However, there is also a very real possibility that an expectation bias plays a role in the perceived improvements observed with brace use (50). An expected, meaningful outcome that patients attribute to using a brace is likely to influence results, regardless of whether or not substantial biomechanical effects truly exist (51).…”

Section: Discussionmentioning

confidence: 99%

Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

Moyer

Birmingham

Bryant

et al. 2015

Arthritis Care & Research

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Objective. To evaluate the effects of valgus knee bracing on pain and function, and compliance and complications, in patients with medial knee osteoarthritis (OA). Methods. A meta-analysis of randomized controlled trials that compared changes in patient-reported pain and/or function in patients with medial knee OA was performed. Seven databases were searched from their inception to January 2014. Two reviewers independently determined study eligibility, rated risk of bias, and extracted data. Pooled estimates and 95% confidence intervals (95% CIs) for standardized mean differences (SMDs) for the improvement in pain (and function) were calculated. Event rates (proportions) were calculated for studies that reported complications.

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Section: Discussionmentioning

confidence: 99%

Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

Moyer

Birmingham

Bryant

et al. 2015

Arthritis Care & Research

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“…In most of the cases, we found pharmacological evidence for the new uses recorded (Table 2), however further studies should be carried out to study the therapeutic effects of timzurri (Lavandula dentata). Although pharmacological and phytochemical studies find evidence for the medicinal use of herbal remedies, locally perceived efficacy of these remedies may be influenced by cultural constructs of efficacy and the meaning response (Moerman & Jonas, 2002). Claming evidence for safe use only on experimental studies fails to integrate local perceptions of health and illness (Wayland, 2004).…”

Section: New Therapeutic Applications Of the Most Important Local Plantsmentioning

confidence: 99%

An ethnomedicinal survey of a Tashelhit-speaking community in the High Atlas, Morocco

Teixidor‐Toneu

Martin²,

Ouhammou

et al. 2016

Journal of Ethnopharmacology

117

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ethnomedicinal survey of a Tashelhitspeaking community in the High Atlas, Morocco, Journal of Ethnopharmacology, http://dx.doi.org/10. 1016/j.jep.2016.05.009 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. ABSTRACT Ethnopharmacological relevanceTraditional knowledge about medicinal plants from a poorly studied region, the High Atlas in Morocco, is reported here for the first time; this permits consideration of efficacy and safety of current practices whilst highlighting species previously not known to have traditional medicinal use. Aim of the studyOur study aims to document local medicinal plant knowledge among Tashelhit speaking communities through ethnobotanical survey, identifying preferred species and new medicinal plant citations and illuminating the relationship between emic and etic ailment classifications. Materials and methodsEthnobotanical data were collected using standard methods and with prior informed consent obtained before all interactions, data were characterized using descriptive indices and medicinal plants and healing strategies relevant to local livelihoods were identified.Results 151 vernacular names corresponding to 159 botanical species were found to be used to treat 36 folk ailments grouped in 14 biomedical use categories. Thirty-five (22%) are new medicinal plant records in Morocco, and 26 described as used for the first time anywhere. Fidelity levels (FL) revealed low specificity in plant use, particularly for the most commonly reported plants. Most plants are used in mixtures. Plant use is driven by local concepts of disease, including "hot" and "cold" classification and beliefs in supernatural forces. 2 ConclusionLocal medicinal plant knowledge is rich in the High Atlas, where local populations still rely on medicinal plants for healthcare. We found experimental evidence of safe and effective use of medicinal plants in the High Atlas; but we highlight the use of eight poisonous species.

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“…The most recent and least heeded definition is that by Moerman, Brody and Jonas that defines placebo effects as 'effects due to the meaning of an intervention' [20][21][22]. This definition is an important improvement on older attempts.…”

Section: Notions and Definitionsmentioning

confidence: 99%

Placebo controls: historical, methodological and general aspects

Walach

2011

Phil. Trans. R. Soc. B

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Control conditions were introduced through the trial of Mesmerism in Paris. Placebo controls became codified standard in 1946. Although seemingly unchallenged, there are various problems with this received view. The notion of a placebo is only defined from the negative. A positive notion proposed that placebo effects are effects owing to the meaning an intervention has for an individual. Thus, placebo effects are individualized, whereas standard research paradigms reveal only grossly averaged behaviour. Also, placebo effects are context sensitive, dependent on psychological factors such as expectancy, relief of stress and anxiety, and hence can generate strong and long-lasting treatment effects. These, however, are not predictable. Such a situation can lead to the efficacy paradox: sometimes, sham interventions can be more powerful than proved, evidence-based treatments. This situation has methodological consequences. Placebo-controlled randomized trials reveal only part of the answer, whether an intervention is effective. This is valuable information for regulators, but not necessarily also for patients and of limited value for providers. Hence, I have argued that we need to complement the hierarchical model of evidence by a circular one, in which various methods are employed on equal footing to answer different questions.

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Deconstructing the Placebo Effect and Finding the Meaning Response

Cited by 642 publications

References 45 publications

Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

An ethnomedicinal survey of a Tashelhit-speaking community in the High Atlas, Morocco

Placebo controls: historical, methodological and general aspects

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