Understanding the Placebo Effect in Complementary Medicine: Theory, Practice, and Research

By David Peters | Go to book overview

2
Towards a scientific understanding of
placebo effects
Edzard Ernst
What are placebo effects and placebos?
Various facets of placebo effects
The 'perceived' placebo effect
The 'true' placebo effect
Further placebo-related terms
Can we be sure that placebo effects exist?
Placebo 'myths'
How do placebos work?
Which factors determine the size of placebo effect?
Nature of intervention
The therapist
The time factor
The patient
The nature of the complaint
The therapeutic setting
The 'pharmacology' of placebos
Placebos in clinical practice
Conclusion

Editor's note

Professor Ernzt reminds us that the term 'placebo response' includes and thereby confuses and obscures a host of ill-understood effects; effects that influence all forms of therapy to a greater or lesser degree. Improving certain aspects of the therapeutic encounter may enhance the outcome of any treatment, so Professor Ernzt encourages practitioners to learn about these elements and to use them well in everyday practice. He reminds us that the phrase so often used about complementary medicines, that they are 'just placebo', typifies the denial and misunderstanding of the many non-specific effects that contribute to self-healing responses and therapeutic outcomes. As science comes to understand consciousness and mind—body inter-relatedness better and can tease out the processes presently hidden in the black box we call 'placebo effects' the notion will almost certainly be abandoned.

The 'three stages of an artefact' seem to fit perfectly the historical development of the placebo effect: initially an 'artefact' is ignored, subsequently it is controlled for its presumed contaminating effects, then finally it is recognized and investigated as a phenomenon in its own right (Harrington 1997). Certainly placebo effects have been ignored and controlled (e.g. in controlled clinical trials). Only recently have we begun to realize their true importance and are directing systematic research towards it. Yet even today clinicians feel 'a shudder of discomfort like a cold hand in the dark' when

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