Reframing placebo in research and practice

Abstract

The terms 'placebo' and 'placebo effects' cause confusion among patients, practitioners and scientists. This confusion results in both the adoption of practices that have no evidence of specificity yet considerable risk (such as surgery for low back pain) or the elimination of clinical practices proven to facilitate healing because they are not 'better than placebo' (such as acupuncture for low back pain). In this article, I discuss these issues and introduce the concept of optimal healing environment as a framework for disentangling what is useful from placebo research for adopting into clinical practice in a manner that is ethical and evidence-based.

Figures

Figure 1.

Hypothetical example showing differential importance of MAC effects. The histograms show two treatments for the same condition with different proportion of context and specific effects. Treatment A has a large proportion of effect provided by means of MAC effects. Conversely, treatment B has a small contribution by MAC and a larger part by specific effects. White bars, specific; grey bars, MAC.