A previous post discussing placebo and placebo effects generated a bit of interest and some discussion. One of the key players in the literature referenced was Professor Ted Kaptchuk. Professor Kaptchuk has recently published a perspective piece titled Placebo Effects in Medicine in The New England Journal of Medicine. It’s open access and definitely worth a read. A few highlights:
“Placebo effects are often considered the effects of an “inert substance,” but that characterization is misleading. In a broad sense, placebo effects are improvements in patients’ symptoms that are attributable to their participation in the therapeutic encounter, with its rituals, symbols, and interactions.”
“Moreover, recent clinical research into placebo effects has provided compelling evidence that these effects are genuine biopsychosocial phenomena that represent more than simply spontaneous remission, normal symptom fluctuations, and regression to the mean.”
“…placebo effects are not just about dummy pills: the effects of symbols and clinician interactions can dramatically enhance the effectiveness of pharmaceuticals.”
“What are the relationships among attention, gaze, touch, trust, openness, confidence, thoughtful words, and manner of speaking that can together reduce perceived discomfort, disability, and disfigurement?”
“Placebo effects are often considered unworthy and illegitimate. They are thought to be unscientific and caused by bias and prejudice. This attitude obscures a core truth of medicine: medicine’s goal is to heal, which can include cure, control of disease, and symptom relief or provision of comfort.”
“Medicine has used placebos as a methodologic tool to challenge, debunk, and discard ineffective and harmful treatments. But placebo effects are another story; they are not bogus. With proper controls for spontaneous remission and regression to the mean, placebo studies use placebos to elucidate and quantify the clinical, psychological, and biologic effects of immersion in a clinical environment”
There’s also an interview with Professor Kaptchuk that you can listen to here.
There’s an updated definition in all of this for this thing that in the past has been refereed to as the placebo effect, perhaps something along the lines of – biopsychosocial phenomena with complex neurobiological substrates, that represent improvements in patients’ symptoms that are attributable to their participation in a therapeutic encounter (or action) with its inherent ritual and symbolism, and the context dependent interaction between relationship, expectation, beliefs, values, attention, gaze, touch, trust, openness, confidence, thoughtful words, and manner of speaking.
It seems a shame to discard as ‘unworthy and illegitimate’ these powerful phenomena in the trash can labelled ‘placebo’.