Placebo interventions, placebo effects and clinical practice

Abstract

This article reviews the role of placebo interventions and placebo effects in clinical practice. We first describe the relevance of different perspectives among scientists, physicians and patients on what is considered a placebo intervention in clinical practice. We then summarize how placebo effects have been investigated in randomized controlled trials under the questionable premise that such effects are produced by placebo interventions. We further discuss why a shift of focus from the placebo intervention to the overall therapeutic context is necessary and what research methods can be used for the clinical investigation of the relevance of context effects. In the last part of the manuscript, we discuss why placebo or context effects are seen as positive in clinical practice when they are associated with active treatments, while placebo interventions pose major ethical and professional problems and have to be avoided.

Methodological Issues of using Placebos in Interventions Based on Digital Technology

“…Further, investigation into cumulative effects of individuals receiving placebos over time does not as yet show effective ways of estimating the effect of placebo. 11 Whilst the best use of placebo employs RCT double blind methodology (e.g. BOTXN versus saline injections) with a no-treatment control group, even this complicates methodology by introducing a third group.…”

“…Context effects and impacts in medicine, so-called 'optimal healing environments' are well researched, and include factors such as expectations to treatment and empathy. 11,16 For example, delivery tends to work better if a drug is subcutaneously injected as opposed to taken orally, it is also better if given with empathy rather than neutral manner. 11,18 Placebo effects are also larger when the mode of delivery is physical (see the placebo object below), as opposed to pharmacological or psychological.…”

“…11,16 For example, delivery tends to work better if a drug is subcutaneously injected as opposed to taken orally, it is also better if given with empathy rather than neutral manner. 11,18 Placebo effects are also larger when the mode of delivery is physical (see the placebo object below), as opposed to pharmacological or psychological. 19 Placebo delivery with digital technology is as much to do with rituals, or activities that routinely occur in a set order, as well as ideas surrounding computers and mobile technology during interaction that surrounds patient consultation.…”

Introduction to placebo effects in medicine: mechanisms and clinical implications

“…Linde et al [57] discuss reasons for using placebos in clinical practice and suggest that the perspectives of physicians, scientists and patients about placebo may substantially diverge. Using placebo interventions in medical practice is rather frequent, but is in contrast with the professional imperative of specific and indicated treatment as it is conventionally taught in medical education, and consequently points to a considerable amount of treatment uncertainty among physicians.…”

“…During the pre-pharmacological age it was quite customary to distribute sugar pills or other pharmacologically inactive substances to sooth the patient, to test for 'real illness' or to placate people, when no real effective treatment was known [44]. Even nowadays, physicians and nurses use placebo interventions regularly in clinical practice for very similar reasons as the healers did before the rise of modern medicine [57]. However, the deliberate use of placebo interventions bears severe ethical problems as the patient has to be deliberately deceived by the therapist.…”